CTF | Gourmet Garage PH

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GARAGE

Customer Contact Tracing Form

How are you feeling today?

Customer Name

Phone

Address

Email

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing the symptoms: fever, cough, sore throat

I haven’t been in close contact with a Covid-19 patient in the last 14 days

Service Date

I hereby authorize Gourmet Garage Subic / Omnivores Inc., to collect my data indicated herein for the purposes of effecting control of the COVID-19 infection. I understand that my personal information is protected by RA 10173, Data Privacy Act of 2012.