EmployeeVisitors

1. Are you presently suffering from any of the symptoms listed below and have you been requested for self-isolation or PCR test by medical Doctor /Authority?

YesNo

2. How many doses of vaccination completed?

0 1 2 3 4

3. I have come into a close contact with someone notified as having positive COVID-19, someone who is currently under quarantine or someone who was tested for COVID-19 and the result is still pending?

YesNo

4. Are you fit to Work?

YesNo

People of any age with the following conditions are at increased risk of severe illness from COVID-19 and Need to Take Extra Precautions

(Serious heart conditions, Chronic lung disease, Chronic Kidney disease, Chronic Liver disease, Cancer Patient, Pregnancy, Chronic condition, uncontrolled blood pressure, uncontrolled Diabetes, obesity).

I, (My name mentioned below) acknowledge that the above information is correct, and I do accept the consequences on false information.