Professional Documents
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Public Health Locator Form Public Health Locator Form
Public Health Locator Form Public Health Locator Form
This FORM will be used by government officers for the safety and protection This FORM will be used by government officers for the safety and protection
of the general public in an advent of any communicable disease. The information of the general public in an advent of any communicable disease. The information
provided herein will be very valuable in the containment and contact tracing of any provided herein will be very valuable in the containment and contact tracing of any
communicable diseases. Please fill this out completely and accurately. communicable diseases. Please fill this out completely and accurately.
For visitors accompanying family members with the same address, please indicate their name/s at the back For visitors accompanying family members with the same address, please indicate their name/s at the back
of this form. of this form.
Signature Signature
By affixing my signature, I attest to the truth and veracity of the above information. I understand the need By affixing my signature, I attest to the truth and veracity of the above information. I understand the need
for the collection of the data and consent thereto. for the collection of the data and consent thereto.
NAME/S OF FAMILY MEMBER/S NAME/S OF FAMILY MEMBER/S