Visitor's Health Declaration Form
Questions marked with a * are required
100%
Name of Visitor
Company name
Contact number
Email address
Intended Date of Visit
Purpose of Visit
Lawyer-in-charge
Visit Location
Have you just returned from abroad within the last 14 days?
Have you been in contact with someone who has returned from abroad within the last 14 days?
Do you have a household member issued with a Home Quarantine Order or the Stay-Home Notice?
Are you feeling unwell?
I certify that the above responses are true, accurate and complete.
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