Please Read

I hereby authorized CTI / Affiliate companies to collect and process the data herein required to be provided for the purpose of COVID19 prevention, preparedness and control. I understand that I am required to accomplished this daily health assessment as part of RA 11469 (Bayanihan to Heal as One Act) to provide truthful information.

I agree

Registration

Are you assigned at the main office?

Yes

CTI ID:

Name:

Company:

Department:

Position:

Birthday:

Signs and symptoms

Are you experiencing any of the following :

Ikaw ba ay nakakaramdam ng mga sumusunod?

Wala(None)

Ubo(Cough)

Sipon(Colds)

Lagnat(Fever)

Hirap sa paghinga

Sore Throat

Contact/Exposure:

Have you been exposed to SUSPECTED, PROBABLE or CONFIRMED COVID 19 case for the past 14 days?

Pumunta ka ba sa ospital/COVID 19 testing center/clinic/quarantine facility na pinagdadalahan ng mga COVID 19 positive, suspect, o probable cases?

If this incident has been reported to the lobby this week, please choose NO.

Yes

Contact/Exposure:

In the past 14 days, have you had contact with anyone that had any of the following fever, cough, colds, difficulty in breathing, sore throat?

Sa loob ng 14 na araw, ikaw ba ay nagkaroon ng contact sa taong may lagnat, ubo, sipon, hirap sa paghinga or sore throat?

If this incident has been reported to the lobby this week, please choose NO.

Yes

Travel:

Have you traveled within or outside the Philippines for the past 14 days?

Ikaw ba ay nagtravel sa loob o labas ng Pilipinas sa loob ng 14 araw?

If this incident has been reported to the lobby this week, please choose NO.

Yes work related

Yes personal choice

Social Gathering :

Have you attended any social gathering for the past 14 days?

Ikaw ba ay dumalo sa pagtitipon sa loob ng 14 na araw?

If this incident has been reported to the lobby this week, please choose NO.

Yes