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(Template) Daily Health Status Update of <Staff Name>
To be filled and submitted daily before 6pm.
Name:
Employee ID:
Designation:
Department:
Reporting to:
If you have any question regarding this form, please contact
HR .....
HOD ...
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* Indicates required question
Status
*
Work as Normal (Office, Client's Office etc)
Work From Home
Medical Leave
On Leave but Non Medical Leave
Your Body Temperature
*
Equals or Lower than 37.5 celsius
Above 37.5 celsius
Tick Below if You have any Symptoms. Leave Blank if NONE.
Fever
Dry Cough
Body Aches
Headaches
Sore Throat
Runny nose
Tiredness
Shortness of Breath
Watery, Red, Swollen Eyes
Other:
Has any person(s) you stay with shown any symptom above
*
Yes
No
Has any person(s) you stay with been overseas or outstation lately ?
*
Yes.
No
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