Daily health temperature checks and travel movement declaration form for contractors, tenants and visitors.

65 Sungei Kadut Street 1 Singapore 729377
Daily health temperature checks and travel movement declaration form for contractors, tenants and visitors.
1) Date
DayMonthYear
2 digit day, 2 digit month, 4 digit yearDateHourMinutesAM/PM Option
2) Name
First NameLast Name
3) Phone Number
Area CodePhone Number
4) What is your temperature?
°C
5) Do you have any COVID-19 symptoms or respiratory symptoms such as: Fever (over 37.5 degrees)/ cough/ flu/ breathing difficulties/ block nose/ loss sense of smell or taste?
5A) If the above answer is yes, please specify the details. Otherwise, indicate N.A
6) Have you been exposed to anyone that has been tested positive with COVID-19 OR have any close contact with someone who is under quarantine order/ stay home notice or leave of absence in the last 4 weeks? Did you traveled overseas or have you been to any known Covid-19 clusters in the last 4 weeks?
6A) If any of the above answer is yes, please specify the details. Otherwise, indicate N.A
7) Have you undergone covid-19 swab test? Have you downloaded the "TraceTogether Apps", keep it updated and switch on the blue-tooth at all times? For S pass and work permit holders, have you downloaded the "SgWorkPass Apps"? For dormitory residents, have you downloaded the "FWMOMCare Apps"? And do you have a bottle of hand sanitizer with you?
7A) If any of the above answer is no, please specify the details. Otherwise, indicate N.A
Signature
Clear
I confirm that the information given in this form is true, complete and accurate. By signing this form, i have undergone PCCP SMM (Poh Cheong Concrete Product Pte Ltd Safe Management Measures) induction and understand my obligations to adhere with all the rules and regulations stated inside PCCP SMM. Under COVID-19 (Temporary Measures) Act 2020, A person who, without reasonable excuse, contravenes a control order (Control order to prevent spread of COVID-19), commits an offence and shall be liable on conviction to a fine not exceeding $10,000 or to imprisonment for a term not exceeding 6 months or to both.
Should be Empty: