Isilah dengan jujur demi keselamatan bersama
Name
Address
Birth Date
Pasport Number
Date
Phone Number
Do you have high temperature (feeling hot to touch on the chest or tummy) ?
Do you have sore throat ?
Do you have cough ?
Do you have complaints Shortness of breath / Shortness of breath / Heavy breathing ?
Have someone with a confirmed case of COVID 19 been in close contact with you?Contact means :
