Onehalf Daily Health Check

DAILY HEALTH CHECK

Employee ID Number *

Date

Full Name *

Department *

Position *

Work Arrangement *

Work From Office

Work From Home

Stay In

Are you experiencing Fever? *

Yes

If YES, since when?

Are you experiencing Cough and/or Colds? *

Yes

If YES, since when?

Are you experiencing Sore Throat? *

Yes

If YES, since when?

Are you experiencing Chest Pains or Pressure? *

Yes

If YES, since when?

Are you experiencing Headache? *

Yes

If YES, since when?

Are you experiencing Difficulty in Breathing or Shortness of Breath? *

Yes

If YES, since when?

Are you experiencing Loss of Taste? *

Yes

If YES, since when?

Have you worked together or stayed in the same close environment of a confirmed COVID-19 case? *

Yes

Have you had any contact with anyone with Fever, Cough, Colds and Sore Throat in the past 2 weeks? *

Yes

Have you traveled anywhere (other municipalities / provinces) ASIDE from your home-office route? *

Yes

If YES, specify ALL locations and when?

I hereby authorize ONEHALF STAFFING SOLUTIONS, to collect and process the data indicated herein for the purpose of effecting control of the COVID-19 infection. I understand that my personal information is protected by RA10173, Data Privacy Act of 2012, and that I am required by RA11469, Bayanihan to Heal as One act, to provide truthful information.

I AGREE AND AUTHORIZE