Only World Group

    SECTION A - PERSONAL DETAILS



    Gender MaleFemale
    Living Area

    Company Name & Location

    Visiting Purpose

    SECTION B - HEALTH DECLARATION

    Have you visited any red zones (area, state or countries) during the entirity of the MCO period?
    YesNo
    Have you been in close contact with any suspected or positive Covid-19 patients?
    YesNo
    Have you participated in any of the positive Covid-19 clusters events declared by Kementerian Kesihatan Malaysia?
    YesNo
    Have you displayed any of the following symptoms in the last 14 days?
    FeverSore ThroatCoughBreathing Difficulty
    Other

    SECTION C - CHECKLIST

    Wearing Mask
    YesNo
    Hand sanization
    YesNo