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GENERAL-SANTOS-CITY-traveller-slip - VELASCO

This document contains a QR ID number and COVID-19 monitoring slip for Vincent John Velasco. It provides his personal information including name, address, flight details, and health screening information. According to the form, he arrived from Pasay City on July 30, 2020 and does not have any symptoms of illness. He will undergo home quarantine with two relatives and is required to present medical certificates, test results, and travel authority documents. The form warns that providing untruthful health information can result in penalties under RA 11332.

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Vince Velasco
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74 views1 page

GENERAL-SANTOS-CITY-traveller-slip - VELASCO

This document contains a QR ID number and COVID-19 monitoring slip for Vincent John Velasco. It provides his personal information including name, address, flight details, and health screening information. According to the form, he arrived from Pasay City on July 30, 2020 and does not have any symptoms of illness. He will undergo home quarantine with two relatives and is required to present medical certificates, test results, and travel authority documents. The form warns that providing untruthful health information can result in penalties under RA 11332.

Uploaded by

Vince Velasco
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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QR ID NUMBER

(To be issued at Gensan Airport/Border Checkpoints) Must be activated within 24 hours upon arrival at their residences

GENERAL SANTOS CITY


COVID19 TRACE and PROTECT MONITORING SLIP
PART I. PERSONAL INFORMATION

Surname:VELASCO First Name:VINCENT JOHN Middle Name DAPILAGA


Address (General Santos City Residence) Age: 25 Sex: MALE
Blk/House No./Lot No.: Street/Subdivision/Zone/Purok: Religion: ROMAN CATHOLIC
DELCO RESIDENCE BLOCK 9 PAPARON SUBDIVISION
Food Restrictions: [ X] NONE [ ] HALAL [ ] OTHERS
Barangay: Contact No: Food Allergies:
CITY HEIGHTS 09125868355
Status : [ ] ROF [ X ] LSI'S [ ] OTHERS
Flight No./Plate No:  PR453 Airline/Vehicle Type:: PHILIPPINE AIRLINES
Place of Origin: [ X ] DOMESTIC [ ] INTERNATIONAL City of Origin: PASAY CTY

City's Border Time Arrival (Entry):  10:10 AM (7/30/2020) Preferred Quarantine Facility (For Approval by City Health Office)
Border Assigned Personnel:  TAXI DRIVER [ X ] Home [ ] LGU Provisions
PART II. HEALTH MONITORING

For Home Quarantine; Family Relative Staying With: Age: Indicate if Pregnant or with Chronic Disease
 JAY CARLO BAGAYAS  22  N/A
 MILES DELCO  23  N/A
     
Symptoms of Influenza-Like Illness In the past three (3) days Requirements

Fever (≥38C) [ ] YES [ X ] NO Sore Throat [ ] YES [ X ] NO Medical Certificate [ X ] YES [ ] NO

Cough [ ] YES [ X ] NO Runny Nose [ ] YES [X ] NO Rapid Antibody Test Result: Date Tested:

Diarrhea [ ] YES [ X ] NO Body Ache [ ] YES [ X ] NO RT-PCR Test Result: Date Tested:
 
Travel Authority [ X ] YES [ ] NO
Senior Citizen [ ] YES [X] NO PWD [ ] YES [X ] NO Certificate of Acceptance [ ] YES [ X ] NO

R.A. 11332: YOU ARE REQUIRED TO PROVIDE TRUTHFUL INFORMATION ABOUT YOUR HEALTH CONDITION
Non-cooperation of person that should report or respond to health events or public concerns shall be penalized by the law

QR ID NUMBER
(To be issued at Gensan Airport/Border Checkpoints) Must be activated within 24 hours upon arrival at their residences

GENERAL SANTOS CITY


COVID19 TRACE and PROTECT MONITORING SLIP
PART I. PERSONAL INFORMATION

Surname:VELASCO First Name:VINCENT JOHN Middle Name DAPILAGA


Address (General Santos City Residence) Age: 25 Sex: MALE
Blk/House No./Lot No.: Street/Subdivision/Zone/Purok: Religion: ROMAN CATHOLIC
DELCO RESIDENCE BLOCK 9 PAPARON SUBDIVISION
Food Restrictions: [ X] NONE [ ] HALAL [ ] OTHERS
Barangay: Contact No: Food Allergies:
CITY HEIGHTS 09125868355
Status : [ ] ROF [ X ] LSI'S [ ] OTHERS
Flight No./Plate No:  PR453 Airline/Vehicle Type:: PHILIPPINE AIRLINES
Place of Origin: [ X ] DOMESTIC [ ] INTERNATIONAL City of Origin: PASAY CTY

City's Border Time Arrival (Entry):  10:10 AM (7/30/2020) Preferred Quarantine Facility (For Approval by City Health Office)
Border Assigned Personnel:  TAXI DRIVER [ X ] Home [ ] LGU Provisions
PART II. HEALTH MONITORING

For Home Quarantine; Family Relative Staying With: Age: Indicate if Pregnant or with Chronic Disease
 JAY CARLO BAGAYAS  22  N/A
 MILES DELCO  23  N/A
     
Symptoms of Influenza-Like Illness In the past three (3) days Requirements

Fever (≥38C) [ ] YES [ X ] NO Sore Throat [ ] YES [ X ] NO Medical Certificate [ X ] YES [ ] NO

Cough [ ] YES [ X ] NO Runny Nose [ ] YES [X ] NO Rapid Antibody Test Result: Date Tested:

Diarrhea [ ] YES [ X ] NO Body Ache [ ] YES [ X ] NO RT-PCR Test Result: Date Tested:
 
Travel Authority [ X ] YES [ ] NO
Senior Citizen [ ] YES [X] NO PWD [ ] YES [X ] NO Certificate of Acceptance [ ] YES [ X ] NO

R.A. 11332: YOU ARE REQUIRED TO PROVIDE TRUTHFUL INFORMATION ABOUT YOUR HEALTH CONDITION
Non-cooperation of person that should report or respond to health events or public concerns shall be penalized by the law

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