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  • Visitor and Employee Health Screening Form

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    Puche Mara
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    This document is a treatment form from Pangalcagan National High School in Bugasong, Antique, Philippines. It is a self-declaration form for visitors to complete, asking if they have traveled to high-risk COVID areas, had contact with COVID patients, or experienced symptoms in the last 14 days. It collects the visitor's name, phone number, who/office they are visiting, purpose of visit, and temperature.

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    visitor and employee health screening form

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    This document is a treatment form from Pangalcagan National High School in Bugasong, Antique, Philippines. It is a self-declaration form for visitors to complete, asking if they have traveled to high-risk COVID areas, had contact with COVID patients, or experienced symptoms in the last 14 days. It collects the visitor's name, phone number, who/office they are visiting, purpose of visit, and temperature.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    4 views1 page

    Visitor and Employee Health Screening Form

    Uploaded by

    Puche Mara
    This document is a treatment form from Pangalcagan National High School in Bugasong, Antique, Philippines. It is a self-declaration form for visitors to complete, asking if they have traveled to high-risk COVID areas, had contact with COVID patients, or experienced symptoms in the last 14 days. It collects the visitor's name, phone number, who/office they are visiting, purpose of visit, and temperature.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Department of Education

    Region VI-Western Visayas


    Division of Antique
    District of Bugasong
    PANGALCAGAN NATIONAL HIGH SCHOOL

    TREATMENT FORM
    SELF-DECLARATION BY VISITOR

    Have you Have you had Have you


    travelled to close contact experienced any
    identified high with someone cold or flu-like
    TIME Name Phone Number Person/ Office to Visit Purpose of Visit Temp. risk area for diagnosed symptoms in the
    COVID-19 with COVID-19 last 14 days
    within the last within the last (fever, cough,
    14 days? 14 days? shortness of
    breath or other
    respiratory?
    YES NO YES NO YES NO

    Recorded by:

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