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Contact Tracing Logsheet: History of Travel Within The Last 30 Days?

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Contact Tracing Logsheet: History of Travel Within The Last 30 Days?

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CONTACT TRACING LOGSHEET

NOTE: PLEASE USE YOUR OWN BALLPEN.

History of travel
within the last 30
Please check if you have any of the following symptoms. days?
(Pakilagyan ng tsek kung nakakaranas ng mga (Ikaw ba ay may TEMPERATURE SIGNATURE

sumusunod na sintomas): pinuntahang lugar

nitong nakaraan
Date of
CP na 30 na araw?
Visit NAME ADDRESS DESTINATION PURPOSE
NUMBER
1 2 3

Difficulty of breathing
If

Headache
Body weakness
Sore throat

Diarrhea
YES Location

Others
Cough
Fever

Colds
Put (Lugar na
check pinuntahan)

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