\ hereby authorize DISCOVERY CENTRE CONDOMINIUM CORP. to collect and process the data indicated herein forthe purpose of effecting control ofthe ‘COVID19 infecton.| understand that my personal information is proetcted by RA 10173, Data Privacy Act 2012and that | am required by RA 11469, Bayanihan to Heal as One Act, to provide truthful information. |Signature: Date: "For related concer, lease contact your immediate superisor HEALTH CHECKLIST MONITORING HEALTH CHECKLIST MONITORING eee | fame onde ae Residence: Residence: Nationality Nationality [Nature of — |Emplovee Nature of [Employee Ivisiy (Visitor lvisiy Visitor [Purpose _ |i oficial, fin company detals below [Purpose _|ifofcial fits company detais below [Company [Company Name: Name: [company [company laces: laces: YES NO YES N 2. Sore Throat [renfeny 2. Sore Throat (Pananakit ng Lalamunan) | (Penanakit ng Lalamunan) I Are you experiencing b. Body Pains [Ema |. Are you experiencing b. Body Pains (Nakakeranas ka ba (Pananalet ng Ketawan) (Wakakaranas ka ba (Pananakit ng Katawan) a) . Headache mg) . Headache (Pananakit ng Uio) (Pananakit ng Uo) 4. Fever forthe past fow days 4, Fever forthe past few days (Lagnat sa rakalipas ng mga eraw) (Lagnat sa nakaiipas ng mga arew) 2. Have you worked together or stayed in the same YES NO] J2. Have you worked together or stayed inthe same ves close enviroment ofa confirmed COVID19 case? (May [close enviroment ofa confirmed COVID19 case? (May Inakasama ka ba or nakatrabaho tao nakompirmadong Inakasama ka ba or nakatrabaho tao nakompimadong |may COVID19/nay impeksyon ng coronavirus?) Imay COVID19inay impeksyon ng coronavirus?) '5. Have you had any contact with anyone with fever, YES NO| |3. Have you had any contact with anyone with feve YES |cough,colds, and sore throat in the past two (2) lcough,colds, and sore throat inthe past two (2) LI lweeks? (Mayroonka bang nekasama na may lagnat, ubo, |weeks? (Mayroonka bang nakasama na may lagnat,ubo, sipon or sakit ng atamunan sa nakalipas ng dalawang (2) sipon or sakit ng lalamunan sa nakalipas ng dalawang (2) finggo?) fingao?) |. Have you travelled outside ofthe Philippines in the ES NO| |4. Have you travelled outside ofthe Philippines in the fee llast14 days? (Ikaw ba ay nagbiyahe sa labas ng Pilipinas llast14 days? (Ikaw ba ay nagbiyahe sa labas ng Pilipinas [sa nakalias na 14 na arew) sa nakaipas ne 14 na araw) [5. Have you travelled to any area in NCR aside from ‘YES NO| |5. Have you travelled to any area in NCR aside from ‘YES NC Ihome?(ikaw ba ay nagounta sa ibang parte ng NCR or home?(ikew ba ay nagounta sa ibang perte ng NCR or [Metro Mania bukod sa inyong bahay?) Specty (Sabin |Metro Manilebukod sa inyong bahay?) Speciy (Sabin kung saan kung saan) "hereby authorize DISCOVERY CENTRE CONDOMINIUM CORP. to collect and process the data indicated herein forthe purpose of effecting contol of the ‘COVID19infection.| understand that my personal information is proetcted by RA 10173, Data Privacy Act 2012and that | am required by RA 11469, Bayanihan to Heal as One At, to provide truthful information, [signature Date: [For related concem, please contact your immediate supervisor