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Health Checklist for
Restaurant Support Center

Thank you for taking time to answer this quick information sheet.
This sheet will help us ensure the safety of our customers and employees.

    Office of the COOBusiness PlanningMarket ResearchHRD/TrainingNPD/SPGQABusiness Dev & Lease AdminPurchasingDesign & ConstructionMarketingOperationsMISComplianceFinanceCSCWarehouseMaintenanceCold StorageOthers
    Are you experiencing (Nakakaranas ka ba ng) a. Fever (lagnat) YESNO
    b. Cough and/or colds (ubo at/o sipon) YESNO
    c. Body pains (pananakit ng katawan) YESNO
    d. Sore Throat (pananakit nang lalamunan/masakit lumunok) YESNO
    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?
    (May nakasalamuha ka ba na probable o kumpirmadong pasyente na may COVID-19 mula sa isang metrong distansya or mas malapit pa at tumagal nang mahigit 15 minuto sa nakalipas na 14 araw?)    		 YESNO
    Have you provided direct care for a patient with probable or confirmed COVID-19 case without using proper personal protective equipment for the past 14 days?
    (Nag-alaga ka ba ng probable o kumpirmading pasyente na may COVID-19 ng hindi nakasuot nang tamang personal protective equipment sa nakalipas na 14 araw?)    		 YESNO
    Have you travelled outside the Philippines in the last 14 days?
    (Ikaw ba ay nagbyahe sa labas ng Pilipinas sa nakalipas na 14 na araw?)
    If yes, specify which country you went to (Sabihin kung saan):

    		YESNO
    Have you travelled outside in the current city/municipality where you reside?
    (Ikaw ba ay nagbyahe sa labas ng iyong lungsod/munisipyo?)
    If yes, specify which city/municipality you went to (Sabihin kung saan):

    		 YESNO
    I hereby authorize PPI Holdings, Inc., to collect and process the data indicated herein for the purpose of contact tracing effecting control of the COVID-19 transmission. I understand that my personal information is protected by RA 10173 or the Data Privacy Act of 2012 and that this form will be destroyed after 30 days from the date of accomplishment, following the National Archives of the Philippines protocol.