Contact Tracing Form
This form will be used for Contact Tracing on customers who have visited the Functional Training Institute.

Should you have any queries, please contact Functional Training Institute:
Phone: 6291 2663
Mobile: 9820 9550
Email: info@fti-lwz.com

For the latest updates with regards to the WUHAN CORONAVIRUS (2019-NCOV), please refer to the Ministry of Health (MOH) website at https://www.moh.gov.sg
Email address *
First Name *
Your answer
Last Name *
Your answer
Contact Number *
Your answer
Date of Visit *
MM
/
DD
/
YYYY
Time of Visit *
Time
:
Reason for Visiting *
Body Temperature at Time of Visit *
Health Declaration at Time of Visit *
Required
Travel Declaration at Time of Visit *
PDPA Consent Statement
Functional Training Institute is committed to the safeguarding of your personal information. By submitting this form, you AGREE and CONSENT to the use of your above information for the purpose of Customer Contact Tracing, should the need arises.
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