IMPORTANT REMIDER:

Please accomplish Annex “C” Post Examination Health Surveillance Form

and submit at car.examination@prc.gov.ph on November 30, 2021.

Thank you.

Annex “C”

Post Examination Health Surveillance Form

Instructions: Please continue to follow social distancing and the wearing of face mask
even after the exam. You are required to send an email at car.examination@prc.gov.ph
fifteen (15) days after the last examination date. Please provide truthful information
relative to your health status by November 30, 2021.

Dear PRC,

Good day! I took the Civil Engineers Licensure Examination last November 14 & 15, 2021.
I would like to inform you of my health status as of November 30, 2021.

Name:_______________________________________________
Testing Venue:_____________________________________
Room No: __________
Seat No: ___________

My health status is I (Please check (✓) all relevant items)

___ have no symptom/s.

or
___ am with the following symptom/s:
___ fever
___ cough
___ easy fatigability
___ other signs/ symptoms or remarks: ___________

After completing the message, you will receive an acknowledgment and/or further
instructions from PRC.

SUBMIT TO:

car.examination@prc.gov.ph
DEADLINE OF SUBMISSION:

November 30, 2021