EMPLOYEE HEALTH MONTORING AT HOME

Employee Health Monitoring at Home

NAME: ROSEANNE CARSOLA
DEPARTMENT: PRODUCTION
DATE START OF QUARANTINE: 17-Aug-20
RESIDENCE DURING 14 DAYS QUARANTINE: 3118 GEN P GARCIA ST BANGKAL MAKATI
WHO ARE YOUR HOUSEMATES AS OF TODAY? PLEASE
SPECIFY. JOHANNA NERI GRACE CASICA
Please indicate Yes or No in the following symptoms that you experience during the 14-day peroid.
Symptoms/ Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Day 10 Day 11 Day 12 Day 13 Day 14
Date 8/17/2029 8/18/2029 8/19/2029 8/20/2029 8/21/2029 8/22/2029 8/23/2029 8/24/2029 8/25/2029 8/26/2029 8/27/2029 8/28/2029 8/29/2029 8/30/2029
Sore Throat NO NO NO NO NO NO NO NO NO NO NO NO NO NO
Body Pains NO NO NO NO NO NO NO NO NO NO NO NO NO NO
Headache NO NO NO NO NO NO NO NO NO NO NO NO NO NO
Fever NO NO NO NO NO NO NO NO NO NO NO NO NO NO
Cough NO NO NO NO NO NO NO NO NO NO NO NO NO NO
Difficult in Breathing NO NO NO NO NO NO NO NO NO NO NO NO NO NO
Shortness of Breath NO NO NO NO NO NO NO NO NO NO NO NO NO NO
Runny Nose NO NO NO NO NO NO NO NO NO NO NO NO NO NO
Vomiting NO NO NO NO NO NO NO NO NO NO NO NO NO NO
Diarrhea NO NO NO NO NO NO NO NO NO NO NO NO NO NO
Anosmia (loss of smell) NO NO NO NO NO NO NO NO NO NO NO NO NO NO
Dysgeusia (distortion of sense of taste) NO NO NO NO NO NO NO NO NO NO NO NO NO NO
Temperature
Morning Temperature 36.3 36.4 35.5 35.9 36.1 35.1 35.9 35.8 36 35.9 35.3 35.7 35.7 35.7
Evening Temperature 36.5 36.5 36.5 35.7 35.4 36.5 36.8 36.1 35.2 36.3 35.8 35.6 35.7 35.8

I hereby authorize ARQUEE CORP to collect and process the data indicated herein for the purpose of effecting control of the COVID-19 infection. I understand that my personal information is protected by RA 10173, Data Privacy Act of 2012, and that I am required by RA 11469,
Bayanihan to Heal as One Act, to provide truthful information.

I hereby certify that, to the best of my knowledge, the provided information is true and accurate.
Signature: ROSEANNE M. CARSOLA Date: AUGUST 30, 2020