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HEALTH DECLARATION
ABOUT YOURSELF
HEALTH DECLARATION
1. Do you have a fever or any flu symptoms (cough, runny nose, sore throat)?* If YES, please do not attend the event.
No
2. Have you had close contact with anyone who is diagnosed with Covid-19 or is on Leave of Absence (enforced by the government)? * If YES, please do not attend the event.
No
3. Are you currently on Leave of Absence or a quarantine order (both enforced by the government)? * If YES, please do not attend the event.
No
4. Have you been to any of the high risk countries (as defined by Singaporean government) in the last 30 days? Please regularly check MOH’s website for updates https://www.moh.gov.sg/covid-19 * If YES, please do not attend the event.
No
5. I acknowledge and agree to the collection, use and disclosure of my personal data for the purposes set out in this form.
No
6. I state that the information given in this form is true, complete and accurate. Anyone making false declarations can be prosecuted under the Infectious Diseases Act.
No
SUBMIT
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