• Health Declaration Form

    Health Declaration Form

    COVID 19

  • Your Consent 

    By submitting this form, you agree that European Chamber of Commerce, Singapore may collect, use, process and disclose my personal data for the purposes of contact tracing and other response measures in the event of any emergency. Our collection policy complies with Singapore’s Personal Data and Protection Act (2012).

  • Is this your first time completing the health declaration form?*

  • Personal Particulars

    You will only need to fill in your personal particulars once. It will henceforth be logged in our system.

  • Travel & Health Check

  • 1. Have you returned from China, Republic of Korea, Japan, Northern Italy* or Iran in the past 14 days? *Northern Italy refers to eight administrative regions: Aosta Valley, Piedmont, Liguria, Lombardy, Emilia-Romagna, Veneto, Friuli-Venezia Giulia and Trentino-Alto Adige/Südtirol. The cities of Milan and Venice are in Northern Italy.*
  • 2. Did you, in the past 14 days, come in close contact with someone who (i) Is a confirmed COVID-19 case or (ii) Is part of a COVID-19 cluster?*
  • 3. Have you been in contact with any person/s placed on mandatory Leave of Absence (LOA) / Quarantine Order in the past 14 days?*
  • 4. Are you currently experiencing any of these symptom(s)

  • 5. Have you travelled (within the last 14 days) to ASEAN countries (e.g Brunei Darussalam, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Thailand, Vietnam)?

  •  :
  •  :
  • Should be Empty: