Contact Tracing Form

Given the evolving situation in COVID-19 (Coronavirus Disease 2019), we are taking the necessary measures to ensure the safety and well-being of our customers, staff and the community. As such, we request that you take a couple of minutes to fill in this form before entering our premises. The information gathered will be useful for contact tracing should the need arise.

Thank you for your cooperation.

Your Name (required)

Your Email (required)

Your Contact No (required)

1.Did you travel out of Singapore in the last 14 days? (required)
YesNo
If you answered "Yes", please type out clearly which country you visited. If "No", please type NIL.

2.Are you currently serving a Quarantine Order (QO)? (required)
YesNo
3.Are you currently serving a Leave of Absence (LOA)? (required)
YesNo
4.Are you currently serving a Stay-Home Notice (SHN)? (required)
YesNo
5.Are you feeling unwell or having any respiratory symptoms (such as fever, cough, sore throat or runny nose)? (required)
YesNo
If your answer to any of Q2, Q3, Q4 and Q5 above is "Yes", please contact the staff-in-charge and refrain from dining on our premises. Thank you for your understanding.
By submitting this form, you agree to provide your personal data prior to your visit/ meeting and understand that the data gathered is solely for contact tracing should the need arise.