Health Statement for COVID-19

COVID-19 STATEMENTHealth Statement for COVID-19

Health Statement for COVID-19 Health Statement for COVID-19

In response to the COVID-19 and the quarantine requirements and in reference to the quarantine recommendations issued by the CDC, and further for the purpose of safeguarding all the employees of Tong Hsing Electronic Industries, Ltd. (hereinafter “Tong Hsing”), all visitors must fill out the Health Statement which will be recorded for the understanding of the health status of the visitor. Tong Hsing will destroy the Health Statement in 28 days after Tong Hsing has collected the Health Statement in accordance with the Computer-Processed Personal Data Protection Law. Visitors please fill out the Health Statement before entering to our plant. If you fill out and hand in the Health Statement, it is deemed that you agree to the collection, processing, and usage of personal information by Tong Hsing

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Required Name

Required Phone No.

Required Name of the Company/Department

Required Plant to visit

RequiredDo you have oversea travel history in the past 17 days?

Yes No

Required Do you belong to one of following situations? 1. Suspected case of confirmed case of COVID-19. 2. You or your family members (or your close contacts) have contacted suspected or confirmed case of COVID-19 in the past 17 days. 3. You are currently under home isolation, home quarantine, or self-health monitoring. 4. You have shown COVID-19 related symptoms (such as fever, acute respiratory symptom, diarrhea, s abnormal smell/taste, extreme tiredness, unusual muscle pain).

Yes No

Other comments

Required I hereby acknowledge that the above statements are true and agree to take legal liabilities resulted from providing inaccurate information.

During the pandemic period, please wash your hands frequently and refrain yourself from touching your eyes, nose, mouth and wear a facial mask. If you have any symptoms like cough, please contact the Central Epidemic Command Center (1922) for further medical assistance. Please fill the health statement in honesty and cooperate with us in the quarantine measure.

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