COVID-19 Self-Assessment & Communication

Staff members use only

Dear staff members,

For the health & safety of everyone and better infection prevention & control within our business premises please submit the below form to inform any event related to the current COVID-19 pandemic that affects you.

Should you have any updates including your test confirmation & result, infectious status and any messages regarding COVID-19 you MUST report to management using this form.

If you have a problem submitting the form please email messages & attachments to

    Your Details

    I am reporting for..


    Description of incident

    * The "close contact" is someone who has spent four hours or more with a confirmed case in a household or household-like setting, such as a residential care facility.

    Action taken

    Additional Comment

    Attachment (Max. 8MB each)

    Please attach relevant documentations (e.g. COVID-19 test notifications & result, notice from health authorities or medical documentation)