Professional Documents
Culture Documents
1.Have you been fully vaccinated for COVID-19 during the last 2 weeks? (2 doses, except for ✔
Janssen vaccine which requires only 1 dose)
Sore throat ✔
Body pain ✔
Headache ✔
Fever ✔
Cough ✔
Colds ✔
Difficulty of breathing ✔
Diarrhea ✔
- Nausea/vomiting ✔
Tiredness ✔
Skin rash ✔
Red eyes ✔
3. Have you worked together or stayed in the same close environment with a confirmed COVID-19 ✔
case or PUI who is under self-quarantine in your house or in your neighborhood?
4. Did you have any contact with anyone with fever, cough, colds, and sore throat in the past 14 days? ✔
Ongoing pregnancy ✔
Hypertension ✔
Heart disease ✔
Diabetes mellitus ✔
COPD ✔
Cancer ✔
Blood dyscrasias ✔
Autoimmune disease ✔
Other Illnesses
I fully understand that it is the policy of the Our Lady of Fatima University that no students regardless of status shall be allowed to
report for school on campus if any of the above mentioned conditions are present. A student may only report back to school after
following the 14-day quarantine protocol and submit a medical clearance/fit to school certificate from the School Physician before
reporting on campus.
For students in vulnerable group (VG): I fully understand that I must follow the prevailing guidelines prescribed by the COVID
19
Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF).
I attest that all the information given above are true and correct and that I may be held liable for any misinformation stated herein. I
also authorize Our Lady of Fatima University to collect and process data indicated herein for the purpose of effecting the control of
COVID-19 infection and that my personal information are protected by RA.10173 (Data Privacy Act of 201°C 2) and that I am
required by RA.11469 (Bayanihan to Heal as One Act) to provide truthful information.