Department of Health Department of Health

National Capital Regional Office National Capital Regional Office

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Department of Health Department of Health

National Capital Regional Office National Capital Regional Office

PASS SLIP PASS SLIP

Permit to Enter/Extend Permit to Leave Permit to Enter/Extend Permit to Leave

Date Date

NAME : ___________________________________________ NAME : ___________________________________________

DESTINATION : ____________________________________ DESTINATION : ____________________________________

PURPOSE : ________________________________________ PURPOSE : ________________________________________

__________________________________________________ __________________________________________________
TIME OF DEPARTURE : _______________________________ TIME OF DEPARTURE : _______________________________
EXPECTED TIME OF ARRIVAL : ________________________ EXPECTED TIME OF ARRIVAL : ________________________

Signature of Employee Signature of Employee

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Division/Cluster/Section/Unit Head Division/Cluster/Section/Unit Head