BGHMC Employee Symptom Tracker
A pleasant day to you!

First of all, Thank you for providing your services and being part of the COVID Team!

May we request you to kindly fill up this form so that we can monitor everyone who was at risk of exposure

Kindly answer as truthfully as you can  

If you have any questions, you may ask any of the staff requiring this survey

Thank you and may God Bless you
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Employee ID No.: *
Full Name *
Healthcare Interaction with COVID19 *
If Yes,  Date of Exposure
MM
/
DD
/
YYYY
Status
Date
MM
/
DD
/
YYYY
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