Employee Self Declaration

I acknowledge that I have read and understood

https://jabil.sharepoint.com/en/employees/Jabil

 Language English

1) Employee Number *

10015891

2) Employee Name*

Nurul Shafika Binti Shafei

3) NRIC/Passport *

940907026082

4) Contact Tel *

01151970854

5) Plant*

Plant 1

Plant 2

Plant 3

Plant 5

Plant 6

ICCL/BMW

Plant Batu Kawan

GBS

6) Department*

Facilities Management

7) Please State whether you are experiencing

Fever, Cough, Shortness of breath or diff

to breath, nose block, flu, sore throat , Na
or Vomiting, headache, shivering, tiredne
muscle cramps, diarrhea, loss of smell an
taste senses.

8) Please indicate your My Sejahtera,Home Lo

Red Zone

Success
Green Zone

Others
YOU ARE ALLOWED TO ENTER THE
PLANT.
ANDA DIBENARKAN UNTUK
9) PleaseMEMASUKI
select yourKILANG.
My Sejahtera Risk Profile
Date:
Low Risk 2/17/2022
/Risiko Rendah
EmpName/EmpID: Nurul Shafika
Binti Shafei/10015891
Casual Contact without
Symptoms: No symptoms/Kontak K
MySejahtera Profile: Low Risk /Risiko
Rendah
Casual Contact with symptoms/Kontak Kasu
Suspected Case: No

Person Under Investigation (PUI) / Orang Di B

THANK YOU AND KEEP SCREEN
SHOT AS A PROOF. / TERIMA KASIH
DANPerson
SIMPANUnder SurveilanceSEBAGAI
SCREENSHOT (PUS) / Orang Di B
BUKTI.
Suspected Case/Kes Suspek
OK

10) Do you know if someone staying near to yo

Have you been in contact with people being in
Have you attended any gathering with >20 p
celebration?
Have you received call from Hospital or KKM t
If any of the above is "Yes", then choose "Yes

Yes

No

11) Did you install MySejahtera App in your sm

Yes

No

12) What is your MySJ ID? (Under your MySej

601151970854

15) Have you been fully vaccinated (2 doses)?

Yes

No

16) Have you got an appointment for / or taken

Yes

No

17) Please select your Covid -19 boost dose a

4 Dec 2021

22) I am committed to comply with Covid-19

masks, washing hands and maintain social dis
I hereby declare that the information provide
disciplinary action.*

I acknowledge

Submit