HackerspaceSG visitor declaration form
Hi there, and welcome to HackerspaceSG!

The members of HackerspaceSG would strongly prefer if HackerspaceSG not become a COVID-19 cluster, so we ask that all visitors to HackerspaceSG fill up a health declaration and contact tracing form.

We aim to collect as little information as possible. All collected information will be destroyed after 90 days, or when the authorities deem that contact tracing is no longer necessary, whichever is earlier.

You may be refused entry into the HackerspaceSG premises if you decline to fill up this form. Any HackerspaceSG member may also ask you to immediately leave if we find that you have not filled up this form.

As the form is automatically time-stamped, please fill up the form again even if you have done so before at a previous event.

Please note that false declarations may be prosecuted by the authorities under the Infectious Diseases Act (see https://sso.agc.gov.sg/Act/IDA1976#pr21A- and https://www.channelnewsasia.com/news/singapore/covid19-coronavirus-charged-false-info-moh-contact-tracing-12471894).
Email address *
Name *
Your answer
Contact number *
Your answer
Have you been to mainland China, France, Germany, Iran, Italy, Japan, South Korea, Spain, Switzerland, the United Kingdom, or any other such regions highlighted by the Singapore Ministry of Health, in the past 14 days? *
Have you been in contact with a confirmed COVID-19 patient in the past 14 days? *
If you have the following symptoms, please tick the relevant boxes. (If your symptoms are mild, you may be asked to wear a mask while on the HackerspaceSG premises.) *
Required
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