Salon MCO Guideline | Health Declaration Form For Salon

HEALTH DECLARATION FORM

FOR SALON STAFF

Borang Pengisytiharan Kesihatan untuk pekerja

Full Name

What is your current body temperature ?

Have you been traveling for the pass 14 days?

YES

Have you been in close[1] contact with person suspected to have COVID-19?

YES

Have you had any of the following symptoms over the past 14 days? Please tick if yes.

Fever

Cough

Difficulty in breathing

Sore throat

Other symptoms (please specify) :

[1] Definition close contact :

• Health care associated exposure, including providing direct care for COVID-19 patients, working with health care workers infected with COVID-19, visiting patients or staying in the same close environment of a COVID-19 patient.

• Working together in close proximity or sharing the same classroom environment with a with COVID-19 patient.

• Traveling together with COVID-19 patient in any kind of conveyance.

• Living in the same household as a COVID-19 patient.

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