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COVID-19 Health Checklist Form

This document appears to be a health checklist for contractors or suppliers visiting a company. It collects information such as symptoms like sore throat, body pains, and fever. It also asks if the person has worked near or traveled to areas with confirmed COVID-19 cases, or if they have traveled outside the Philippines in the past 14 days. The checklist is signed by the contractor or supplier to declare their health status.

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Rollie Mimis
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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78 views1 page

COVID-19 Health Checklist Form

This document appears to be a health checklist for contractors or suppliers visiting a company. It collects information such as symptoms like sore throat, body pains, and fever. It also asks if the person has worked near or traveled to areas with confirmed COVID-19 cases, or if they have traveled outside the Philippines in the past 14 days. The checklist is signed by the contractor or supplier to declare their health status.

Uploaded by

Rollie Mimis
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

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NO.

CONTRACTOR/ SUPPLIERS
Bo. Nabilid, Roxas, Zambopanga del Norte

NAME OF CLIENTS/ VISITORS/ GUEST/


EDIBLE OILS PHILS., INC.

DATE
PLACE OF ORIGIN

SORE THOAT

BODY PAINS

HEADACHE

FEVER FOR PAST FEW DAYS

BODY TEMPERTURE, °C

HAVE YOU WORKED


DECLARATION - HEALTH CHECKLISTS

TOGETHER OR STAYED IN
THE SAME CLOSE
ENVIRONMENT OF A
CONFIRMED COVID19 CASE?

HAVE YOU ANY CONTACT


WITH ANYONE WITH FEVER,
COUGH AND SORE THROAT
IN THE PAST 2 WEEKS

HAVE YOU TRAVELLED


OTSIDE PHILIPPINES IN THE
PAST 14 DAYS?

HAVE YOU TRAVELLED TO


ANY AREA IN NCR, CEBU,
CAGAYAN DE ORO CITY
ASIDE FROM YOUR PLACE
OF RESIDENCE?
REMARKS

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