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    Daily Health Record

    Uploaded by

    argel
    The employee daily health check form collects personal information from John Paulo Banting including his name, address, emergency contact, travel history, and symptoms. He answers no to experiencing symptoms like fever, cough or sore throat. John certifies the information is true and consents to the company processing his personal data according to their privacy policy in order to monitor viral disease outbreaks.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Daily Health Record

    Uploaded by

    argel
    27 views1 page
    The employee daily health check form collects personal information from John Paulo Banting including his name, address, emergency contact, travel history, and symptoms. He answers no to experiencing symptoms like fever, cough or sore throat. John certifies the information is true and consents to the company processing his personal data according to their privacy policy in order to monitor viral disease outbreaks.

    Original Title

    DAILY HEALTH RECORD

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    The employee daily health check form collects personal information from John Paulo Banting including his name, address, emergency contact, travel history, and symptoms. He answers no to experiencing symptoms like fever, cough or sore throat. John certifies the information is true and consents to the company processing his personal data according to their privacy policy in order to monitor viral disease outbreaks.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    27 views1 page

    Daily Health Record

    Uploaded by

    argel
    The employee daily health check form collects personal information from John Paulo Banting including his name, address, emergency contact, travel history, and symptoms. He answers no to experiencing symptoms like fever, cough or sore throat. John certifies the information is true and consents to the company processing his personal data according to their privacy policy in order to monitor viral disease outbreaks.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    EMPLOYEE DAILY HEALTH CHECK FORM

    Dear Employee,

    In line with our precautionary measures to prevent the spread of COVID-19, we seek your cooperation and understanding
    in completing this form.

    Thank you,
    TEMPERATURE 36.3

    PERSONAL DATA:
    Name: JOHN PAULO V. BANTING Designation: SITE ENGINEER Department: ENGINEERING
    Current Address: 2092 NATHALENE ST. GREEN MEADOW SUBDIVISION, MABIGA,MABALACAT PAMPANGA
    Civil Status: SINGLE Age: 26 Sex MALE
    In case of emergency, contact:
    Name: LANI BANTING Mobile Number: 09634249162

    Please answer below questions truthfully:


    1. Are you experiencing sore throat (pananakit ng lalamunan/ masakit lumunok)? YES NO

    2. Are you experiencing body pains (pananakit ng katawan? YES NO

    3. Are you experiencing headache (pananakit ng ulo)? YES NO

    4. Are you experiencing fever for the past few days (Lagnat sa nakalipas na mga araw)? YES NO

    5. Have you worked together or stayed in the same close environment of a confirmed COVID-19 case?
    YES NO
    (May nakasama ka ba o nakatrabahong tao na kumpirmadong may COVID-19 I may impeksyon ng coronavirus?)

    6. Have you had any contact with anyone with fever, cough, colds, and sore throat in the past 2 weeks?
    YES NO
    (Mayroon ka bang nakasama na may lagnat, ubo, sipon o sakit ng lalamunan sa nakalipas ng dalawang (2) lingo?)

    7. Have you travelled outside of the Philippines in the last 14 days?


    (Ikaw ba ay nagbyahe sa labas ng Pilipinas sa nakalipas na 14 na araw?) YES NO

    8. Have you travelled to any area in NCR aside from your home?
    (lkaw ba ay nagpunta sa iba pang parte ng NCR o Metro Manila bukod sa iyong bahay?)
    Specify( Sabihin kung saan):

    If YES, please specify:

    By signing below, you hereby certify that the information you provided are true, correct and consent to the processing of your personal information
    by RIMAVEN PROPERTIES, INC. solely for the purpose of preventing viral disease outbreak in the workplace. We are collecting and processing
    your personal information in accordance with the Data Privacy Act of 2012 as we understand the importance of safeguarding the confidentiality
    of your personal information. This will enable us to administer, monitor and maintain a record of your travel history for the covered period.

    JOHN PAULO V. BANTING 03/03/2023


    Signature over Printed Name and Date

    (Please forward a copy of accomplished form to HRD)

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