VISITORS CONTACT TRACING FORM VISITORS CONTACT TRACING FORM

BODY TEMP: _____________________________________________ BODY TEMP: _____________________________________________

DATE AND TIME: __________________________________________ DATE AND TIME: __________________________________________
NAME: __________________________________________________ NAME: __________________________________________________
ADDRESS: _______________________________________________ ADDRESS: _______________________________________________
CONTACT NUMBER: _______________________________________ CONTACT NUMBER: _______________________________________
EMAIL: ___________________________________________________ EMAIL: ___________________________________________________
I hereby authorize Fe del Mundo National High School to collect and process the data herein for the purpose of contract tracing effecting control I hereby authorize Fe del Mundo National High School to collect and process the data herein for the purpose of contract tracing effecting
of the COVID-19 transmission. I understand my personal information id protected by RA 10173 or the Data Privacy Act of 2012 and that this control of the COVID-19 transmission. I understand my personal information id protected by RA 10173 or the Data Privacy Act of 2012 and
form will be destroyed after 30 days from the date of accomplishment following the National Archives of the Philippines protocol. that this form will be destroyed after 30 days from the date of accomplishment following the National Archives of the Philippines protocol.

_____________________________________ _____________________________________
SIGNATURE SIGNATURE

VISITORS CONTACT TRACING FORM VISITORS CONTACT TRACING FORM

BODY TEMP: _____________________________________________ BODY TEMP: _____________________________________________

DATE AND TIME: __________________________________________ DATE AND TIME: __________________________________________
NAME: __________________________________________________ NAME: __________________________________________________
ADDRESS: _______________________________________________ ADDRESS: _______________________________________________
CONTACT NUMBER: _______________________________________ CONTACT NUMBER: _______________________________________
EMAIL: ___________________________________________________ EMAIL: ___________________________________________________
I hereby authorize Fe del Mundo National High School to collect and process the data herein for the purpose of contract tracing effecting control I hereby authorize Fe del Mundo National High School to collect and process the data herein for the purpose of contract tracing effecting
of the COVID-19 transmission. I understand my personal information id protected by RA 10173 or the Data Privacy Act of 2012 and that this control of the COVID-19 transmission. I understand my personal information id protected by RA 10173 or the Data Privacy Act of 2012 and
form will be destroyed after 30 days from the date of accomplishment following the National Archives of the Philippines protocol. that this form will be destroyed after 30 days from the date of accomplishment following the National Archives of the Philippines protocol.

_____________________________________ _____________________________________
SIGNATURE SIGNATURE

VISITORS CONTACT TRACING FORM VISITORS CONTACT TRACING FORM

BODY TEMP: _____________________________________________ BODY TEMP: _____________________________________________

DATE AND TIME: __________________________________________ DATE AND TIME: __________________________________________
NAME: __________________________________________________ NAME: __________________________________________________
ADDRESS: _______________________________________________ ADDRESS: _______________________________________________
CONTACT NUMBER: _______________________________________ CONTACT NUMBER: _______________________________________
EMAIL: ___________________________________________________ EMAIL: ___________________________________________________
I hereby authorize Fe del Mundo National High School to collect and process the data herein for the purpose of contract tracing effecting control I hereby authorize Fe del Mundo National High School to collect and process the data herein for the purpose of contract tracing effecting
of the COVID-19 transmission. I understand my personal information id protected by RA 10173 or the Data Privacy Act of 2012 and that this control of the COVID-19 transmission. I understand my personal information id protected by RA 10173 or the Data Privacy Act of 2012 and
form will be destroyed after 30 days from the date of accomplishment following the National Archives of the Philippines protocol. that this form will be destroyed after 30 days from the date of accomplishment following the National Archives of the Philippines protocol.

_____________________________________ _____________________________________
SIGNATURE SIGNATURE

VISITORS CONTACT TRACING FORM VISITORS CONTACT TRACING FORM

BODY TEMP: _____________________________________________ BODY TEMP: _____________________________________________

DATE AND TIME: __________________________________________ DATE AND TIME: __________________________________________
NAME: __________________________________________________ NAME: __________________________________________________
ADDRESS: _______________________________________________ ADDRESS: _______________________________________________
CONTACT NUMBER: _______________________________________ CONTACT NUMBER: _______________________________________
EMAIL: ___________________________________________________ EMAIL: ___________________________________________________
I hereby authorize Fe del Mundo National High School to collect and process the data herein for the purpose of contract tracing effecting control I hereby authorize Fe del Mundo National High School to collect and process the data herein for the purpose of contract tracing effecting
of the COVID-19 transmission. I understand my personal information id protected by RA 10173 or the Data Privacy Act of 2012 and that this control of the COVID-19 transmission. I understand my personal information id protected by RA 10173 or the Data Privacy Act of 2012 and
form will be destroyed after 30 days from the date of accomplishment following the National Archives of the Philippines protocol. that this form will be destroyed after 30 days from the date of accomplishment following the National Archives of the Philippines protocol.

_____________________________________ _____________________________________
SIGNATURE SIGNATURE