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Travel Declaration Form
We appreciate your cooperation in completing the information required below.
SCREENED BODY TEMPERATURE:
PLEASE INDICATE IF YOU HAVE:
Currently having fever/cough/runny nose/sore throat/shortness of breath.
You have been administered a nasal swab.
Have returned from Iran, Mainland China, Italy, France, Spain, Germany, South Korea, ASEAN countries, in the last 14 days and issued with Stay Home Notice.
Have been in close contact with any confirmed case/s of COVID-19 in the last 14 days
Have been in close contact with any confirmed case/s of COVID-19 in the last 14 days, please provide details:
If you have travelled outside Singapore in the last 14 days, please provide the details and country:
I hereby declare that I have answered the above questions truthfully and to the best of my knowledge.
I agree to inform the management of Le Bistrot du Sommelier if myself &/ close contact/s is/are with Leave of Absence/Stay Home Notice/Quarantine Order by MOH.
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