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COVID-19 RISK FORM 2021
COVID-19 RISK FORM 2021
For the sake of mutual health and safety, please be HONEST in filling out this information.
COVID-19 RISK FORM 2021
  • 1
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  • 3

    Fill in the 6 questions with YES or NO.

    If YES, fill in the answer column with numbers 1 or 5.

    If NO, fill with number 0.

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  • 4

    In the past 14 days,
    have you experienced any of the following:

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  • 5
    Public places: Markets, health care facilities, crowds of people, and others.
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  • 6
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  • 7
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  • 8
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  • 9
    Close contact: Shaking hands, talking, being in one room / one house.
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  • 11
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  • 12
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  • 13
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  • 14
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  • 15

    SORRY, you cannot do Raja Ampat Online Registration.


    High Risk (Resiko Besar) is not allowed to enter Raja Ampat Regency. We recommend that you consult a health worker.

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  • 16

    Thank you for conducting an Honest Covid-19 Risk Self-Assessment.
    Make sure your body is in a healthy condition with a body temperature of

     

    Please continue to Online Registration.

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