Health & Travel Declaration

Your Name *

First Name

Last Name

Name of Child (if present)

12 years and below

First Name

Last Name

Did you enter/return to Singapore in the past 14 days? *

Yes

No

Have you been in close contact with any suspected or confirmed case of COVID-19 infection? *

Yes

No

Are you currently placed on any Stay-Home Notice (SHN) from the Ministry of Health, or Leave of Absence (LOA) by your employer? *

Yes

No

If you have the following symptom(s), please tick the relevant box(es).

Fever

Dry cough

Body aches

Headaches

Sore throat

Runny nose

Tiredness

Shortness of breath