HEALTH SCREENING FORM VISITOR
Dear Sir/Madam,To prevent the spread of COVID-19 in our community and reduce the risk of exposure to any person, we are conducting s simple screening questionnaire. Your participation is important to help us take pre-cautionary measures to protect you and everyone in this building.
Block No.
*
Please Select
BLOCK 1
BLOCK 2
BLOCK 3
Block
Level No.
*
Please Select
LEVEL 1
LEVEL 2
LEVEL 3
LEVEL 4
LEVEL 5
LEVEL 6
LEVEL 7
LEVEL 8
LEVEL 9
LEVEL 10
LEVEL 11
LEVEL 12
LEVEL 13
LEVEL 14
LEVEL 15
LEVEL 16
Level
Unit No.
*
Please Select
UNIT 1
UNIT 2
UNIT 3
UNIT 4
UNIT 5
UNIT 6
UNIT 7
UNIT 8
UNIT 9
UNIT 10
UNIT 11
UNIT 12
UNIT 13
UNIT 14
UNIT 15
UNIT 16
Unit
Owner's / Tenant's Name
*
First Name
Last Name
Owner's / Tenant's Phone Number
*
Visitor will Stay in De Bayu
*
Please Select
STAY OVERNIGHT
STAY UNTIL 12 MIDNIGHT
Reason
*
eg: Visiting
Visitor's Vehicle Reg. No.
*
eg: ABC1543
Date
*
 /
Day
 /
Month
Year
2 digit day, 2 digit month, 4 digit year
Arrival date/ Tarikh masuk
Date
*
 /
Day
 /
Month
Year
2 digit day, 2 digit month, 4 digit year
Departure date / Tarikh keluar
VISITOR'S DETAILS
*
Submit
Should be Empty: