DOLE X - HEALTH CHECKLIST
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Input Details
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Employee ID
First Name
Last Name
Office
REGIONAL OFFICE
CAGAYAN DE ORO FIELD OFFICE
BUKIDNON FIELD OFFICE
CAMIGUIN FIELD OFFICE
LANAO DEL NORTE FIELD OFFICE
MISAMIS OCCIDENTAL FIELD OFFICE
MISAMIS ORIENTAL FIELD OFFICE
Division
ORD
TSSD
IMSD
MALSU
Email Address
Mobile Number
Body Temperature
1. Are you experiencing Fever?
YES
NO
2. Are you experiencing Body Pain?
YES
NO
3. Are you experiencing Cough and/or colds?
YES
NO
4. Are you experiencing Sore throat?
YES
NO
5. Have you had face-to-face contact with a probable or confirmed COVID-19 case within 1 meter and for more than 15 minutes for the past 14 days?
YES
NO
6. Have you had any contact with anyone with fever, cough, cold and sore throat in the past 2 weeks?
YES
NO
7. Have you traveled outside of the Philippines in the last 14 days?
YES
NO
8. Have you traveled to any area in NCR aside from you place of residence?
YES
NO
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Employee ID
First Name
Last Name
Mobile Number
Email Address
Gender
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Male
Female
Office
REGIONAL OFFICE
CAGAYAN DE ORO FIELD OFFICE
BUKIDNON FIELD OFFICE
CAMIGUIN FIELD OFFICE
LANAO DEL NORTE FIELD OFFICE
MISAMIS OCCIDENTAL FIELD OFFICE
MISAMIS ORIENTAL FIELD OFFICE
Division
ORD
TSSD
IMSD
MALSU