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
For the latest updates with regards to the WUHAN CORONAVIRUS (2019-NCOV), please refer to the Ministry of Health (MOH) website at
Date of Visit
Time of Visit
Reason for Visiting
R'4 Private PT
R'4 Group PT
Contractor / Others
Body Temperature at Time of Visit
Between 37.5 - 37.9
Between 38.0 - 38.9
Health Declaration at Time of Visit
No Flu - Like Symptons
Travel Declaration at Time of Visit
I have NOT travel out of Singapore in the last 14 Days.
I have travelled out of Singapore in the last 14 days.
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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