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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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