Please enter your registered employee or student no.
1. Symptoms Declaration - I hereby acknowledge the provisions of RA 11332 known as the "Mandatory Reporting of Notifiable/Communicable Disease:" Section 9: Prohibited Acts - The following shall be prohibited under this Act: *Tampering of records or intentionally providing misinformation; *Non-cooperation of the person or entities identified as having the notifiable disease, or affected by the health event of public concern.
For the past 14 days, have you experience or did you have any of the following signs and symptoms? (Fever, Cough and/or Colds, Body Pains, Sore Throat, Fatique/Tiredness,Headache,Diarrhea passing stools more than 4x a day, difficulty of Breathing, Rashes, Sudden Loss of Smell or Taste)
Yes
No
2. Have you had face-to-face contact with a probable or confirmed COVID-19 case for the past 14 days?
Yes
No
3. Have you traveled in the past 14 days?
Yes
No
