Health Declaration

Email address:

Full Name:

Contact No.

1. Have you travelled outside Singapore within the last 14 days? *
YesNo

2. Have you been in contact with anyone who is suspected to have or/has been diagnosed with Covid-19 within the last 14 days? *
YesNo

3. Do you have any of the following symptoms now or within the last 14 days: Cough, smell/taste impairment, fever, breathing difficulties, body aches, headaches, fatigue, sore throat, diarrhoea, and / or runny nose (even if your symptoms are mild)? *
YesNo

4. Temperature *

5. Vaccination Status *
VaccinatedNot Vaccinated

6. ART Test Image (Please Indicate Clearly Date and name on the test kit) *
.

If you have selected YES to questions 1,2 & 3, you are not permitted to enter the premises. I agree (Please Check)*

I hereby declare all the above information provided above are accurate and I am aware any false declarations may result in prosecution under the Infectious Diseases Act. I agree (Please Check)*