Covid- 19 - Support Foundation

Support Worker Full Name *

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Are you exhibiting any symptoms of Covid-19 (Sore throat, cough, fatigue, shortness of breath, fever)? *

If Yes , please mention it when and where?

Have you been to or through these countries High Risk:- Mainland China, Iran,Italy, South Korea and Moderate Risk:- Cambodia, Hong Kong, Indonesia, Japan, Singapore and Thailand in the past 14 days? *

If yes , please mention it when and where?

Have you been in close contact with someone who has sysmptoms of Covid-19(Coronavirus), a confirmed case of Covid-19, or someone who has travelled to these High Risk Countries:- Mainland China, Iran,Italy, South Korea and Moderate Risk Countries:- Cambodia, Hong Kong, Indonesia, Japan, Singapore and Thailand in the past 14 days? *

If yes , please mention it when and where?

Disclaimer *

The information I have provided above are correct.

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