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Justification Letter

This health form from Kawayam National High School requires individuals to declare that their household has not been in contact with COVID-19 cases and does not exhibit related symptoms. It emphasizes the importance of truthful information and outlines the protection of personal data under the Data Privacy Act. The form will be destroyed 20 days after completion in accordance with national protocols.

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Tricia Galit
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23 views1 page

Justification Letter

This health form from Kawayam National High School requires individuals to declare that their household has not been in contact with COVID-19 cases and does not exhibit related symptoms. It emphasizes the importance of truthful information and outlines the protection of personal data under the Data Privacy Act. The form will be destroyed 20 days after completion in accordance with national protocols.

Uploaded by

Tricia Galit
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Republic of the Philippines

Department of Education
RegVIII – Eastern Visayas
Schools Division Office of Biliran
KAWAYAN NATIONAL HIGH SCHOOL
School ID: 303326
Osmeña Street, Poblacion, Kawayan, Biliran
Email add: kawayan.nhs14@gmail.com
_____________________________________________________________________________________________

HEALTH FORM

I, _______________________ declare that my entire household was not considered a close contact,
suspect, probable, or confirmed COVID-19 case the past 14 days. Further, we do not experience any symptoms
related to COVID-19 such as:

A. Fever G. Fatigue/ Tiredness


B. Cough and colds H. Headache
C. Difficulty of breathing I. Loss of taste or smell
D. Sore throat J. Body Pains
E. Diarrhea

I hereby certify that the information given is true, correct and complete. I understand that any falsified
response may have serious consequences. I understand that my personal information is protected by RA 10173
or the Data Privacy Act of 2012 and that this form will be destroyed after 20 days from the date of
accomplishment, following the National Archives of the Philippines protocol.

________________________ _________________________

Name and Signature Date

*Per DOH DM 2020-0512, testing is performed when there is a particular reason to suspect that an individual
may be infected after symptoms-based screening.

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