NIMBB Health Declaration Form
The information you provide here may be used by public health authorities, in accordance with Philippine legislation, in the context of the public health response to COVID-19. This form must be completed for every entry into the NIMBB building.
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Name *
Please enter your full name (Last name, first name)
E-mail Address *
Please use your UP mail if you have one.
Designation *
Mobile Number *
Enter your mobile number using this format: 09XXXXXXXXX
Date of Entry to NIMBB *
Enter the date and time of entry to the NIMBB building.
MM
/
DD
/
YYYY
Time
:
Body Temperature *
Provide your body temperature reading upon entry.
Are you experiencing any of the following symptoms in the past 7 days? *
Check all that apply.
Required
Have you had face-to-face contact with a suspected or confirmed COVID-19 case within 1 meter and for more than 15 minutes in the past 7 days? *
Have you traveled outside the Philippines in the last 14 days? *
Have you traveled outside the current city/municipality where you reside in the past 7 days? *
If yes, specify which city/municipality you went to:
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