Travel and Health Declaration

For more details, please visit www.mom.gov.sg/wuhanvirus

*This declaration will be used by employers for purposes of obtaining the travel history of employees. The information should not be used for any other purposes. 

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Employee

Name of Employee *

Department *

Nationality *

Travel

1. Did you travel to overseas recently?

1.a. Which countries have you visited?

1.b. When did you last return to Singapore?

Health

2. Have you had close contact* with a person diagnosed as a probable case of COVID-19? *cared for, lived with or had direct contact from a suspect case? *

3. Are you feeling unwell with mild flu-like symptoms, coughing, runny nose, sneezing or breathlessness? *

4. Over the past 7 days has your temperature been above 37.5 °C (99.5 °F)? *