Reference No.

GOLDENSTATE COLLEGE
RF-COO02-750
Date of Page No.
EMPLOYEE LOCATOR FORM Effectivity: Page 1 of 2
Aug. 26, 2020

TO ALL CONCERNED:

The Goldenstate College requires all personnel reporting to school and those who are working from home to diligently
accomplish this locator form. Log in details of your activities whenever you leave to and from the school/home,
include date, time and persons in direct contact with.

This is the College response to trace and monitor personnel movement in time of this health emergency due to
COVID 19. It is important that you honestly declare your whereabouts. Data in this form shall be kept in confidentiality
but shall also be use for contact tracing whenever necessary.

Please affix your signature below if you agree to use your data in this form as the need arises.

Thank you.

____________________________________________________________________________

NAME OF SCHOOL PERSONNEL :

JETHRO DIGNADICE
DEPARTMENT:
College of Information Technology Education
AGE:
30
ADDRESS:
GOLDENSTATE COLLEGE OF KORONADAL CITY
PHONE NO.
09368246631
CONTACT PERSON IN CASE OF EMERGENCY:

WORK ARRANGEMENT :

DATE TIME TO FROM DIRECT CONTACT REMARKS

Feb 14 HOME Family Online class
Feb 15 HONE Family Online class
FEB 16 HOME Family Online class
FEB 17 1:00- KCC Home None Grocery
3:00
FEB 17 3:00- HOME Home
onward
s
FEB 18 Home Family
FEB 19 Home
Family

Note: the Human Resource Officer on a weekly basis.

I hereby affirm that the information provided above are true and correct based on the account of
my transaction.
 Reference No.
GOLDENSTATE COLLEGE
RF-COO02-750
Date of Page No.
EMPLOYEE LOCATOR FORM Effectivity: Page 2 of 2
Aug. 26, 2020

JETHRO DIGNADICE

SIGNATURE OVER PRINTED NAME