Safe Entry | srsupply

QUESTIONNAIRE FOR VISITORS

In view of the evolving Novel Coronavirus (COVID-19) situation and to reduce the risk of exposure, we require all visitors to complete a questionnaire. Your participation will enable us to take precautionary measures to protect you and everyone in the building.

Personal Particulars

Declaration

6. Are you currently on Leave of Absence and/or Stay Home Notice (Refer to MOH's advisory on LOA/SHN)?

7. Do you have family member(s) or friend(s)/ relative(s) who are staying with you, and returned/arrived from overseas in the last 14 days?

*Close contact means having care for, having lived with or having direct contact with respiratory secretions or body fluids of a person with COVID-19.

8. Are you unwell with flu-like symptoms e.g. fever, headache, cough, sore throat, runny nose, breathlessness?

9. Have you been contacted by MOH/MND as part of contact tracing?

10. Please acknowledge the declaration below:

Yes, I hereby declare that I have answered the above questions truthfully and to the best of my knowledge. I understand that omitting to provide as well as providing false information is an offence under the Infectious Disease Act.

End of Survery

Thanks for submitting

SR Supply Pte Ltd

QUESTIONNAIRE FOR VISITORS

Personal Particulars

Declaration

6. Are you currently on Leave of Absence and/or Stay Home Notice (Refer to MOH's advisory on LOA/SHN)?

End of Survery

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