Internal WTS COVID-19 Risk Daily Declaration Form

1

Full Name (as in FIN/NRIC)* This field is required.

2

Last 3 Digit and Alphabet of your FIN/NRIC (SXXXX123A)* This field is required.

3

My answers remain the same as my previous declaration for:

Department

Contact Number

Vehicle License Plate

Travel Location(s) & Date(s)

Exposure to anyone who has or is suspected of having COVID-19

Symptoms of COVID-19

4

Department* This field is required.

5

Department (if you selected "Others")* This field is required.

6

Contact Number* This field is required.

7

Vehicle License Plate

8

Did you travel out of Singapore since 13 January 2020?* This field is required.

YESNO

9

Where and from when to when?

If multiple locations, please list them all.

In this format: DD/MM/YYYY - DD/MM/YYYY

10

Have you been in contact with anyone that has or is suspected of having the COVID-19?* This field is required.

YESNO

11

Tick if you have any of the following

Fever (above 37.5C)

Cough

Runny Nose

Shortness of Breath

12

BY SIGNING, I UNDERSTAND THAT OMITTING TO PROVIDE AS WELL AS PROVIDING FALSE INFORMATION IS AN OFFENCE UNDER THE INFECTIOUS DISEASES ACT AND THE PENAL CODE OF SINGAPORE. THE COMPANY MAY ALSO TAKE DISCIPLINARY ACTIONS AGAINST ME. I AGREE TO ABIDE BY WTS' PRECAUTIONARY MEASURES AGAINST THE 2019 NOVEL CORONAVIRUS (COVID-19)* This field is required.