To: All
Subject: Updated Covid 19 Questionnaire
Objectives: 1. To minimize infection and spread in the office especially that
workplace is a covid 19 spreader
2, To do a constant monitoring of health conditions of our workers
3, To act on symptoms immediately and prevent spread.
Reality: 1. Daily cases reach 5,000 a day; there seems to be no end; total cases have gone past 100,000
2, The govt seems to have given up and seems to have a policy of matira ang matibay; which is unacceptable
What: 1. We will have this questionnaire every month which shall be
analyzed as basis for action
2. This is the latest compilation of what is being done and what
we need to do vs covid19
LATEST UPDATED COVID 19 QUESTIONNAIRE FOR HOLY GARDENS GROUP
Date ____ Region ___ Province ___ Last Questionnaire + -
1. Age __ below 20 __ above 59 __
2. Size of house ____square meters 3. Number of bedrooms __ 4. Number of persons/bedroom
3 Is social distancing observed in your House __Yes __No
4. Was there a visitor in your house other than family members in the last 24 hours? __Yes __No
5. Was there a person, other than family member who slept in your house in the last 24 hrs __Yes __No
6. Have you visited any of the following in the last 24 hours:? Week?
bars and restaurant __Yes __No
supermarket or grocery __Yes __No
church/congregation __Yes __No
gymn __Yes __No
salon, spa,, massage __ Yes __No
TAKEN PUBLIC TRANSPORT
train/mrt/lrt __Yes __No
puv __Yes __No
7 Have you been in close personal contact in the last 24 hours with a person
other than your relative or house members ? __Yes __No
8. Have you visited or near the vicinity of following health facility
Quarantine facility __Yes __No
Health center __Yes __No
Hospital for covid19 __Yes __No
9. Have you been in contact with any of the following for the last week?
ex OFW __Yes __No
residents of Hatid Probinsiya program __ Yes __No
or Tulong Hatid program
10. Symptoms and health manifestations:
Have you experienced any or all of these in the last 24 hours:
1, Sore throat __Yes __No
2. Nausea __Yes __No
3, Loss of smell and appetite __Yes __No
4. Fever (38.2 degrees Celsius or more) __Yes __No
5. Dry cough __Yes __No
6. LBM __Yes __No
7. Depression and worry about PHP and survival __Yes __No
Work conditions
How long since GCQ have you been working continuously ___days?
11. Have you ever been put into quarantine? (enforced or voluntary)
14 days __ Yes __No
21 days __Yes __No
12. Have you been tested? Result if yes
Rapid test __Yes __No + -
Swab test __Yes __No + -
13 Safety procedures/protocol at workplace
1. Are you required to wear face masks when working __ Yes __No
2. Face shield __Yes __No
3 Gloves __ Yes __No
4 PPE during interment __Yes __No
5 Frequent hand washing __Yes __No
6. Is alcohol available for disinfection/hand washing
7. Are there daily disinfection routine being done at your SBU __Yes __No
8. Are toilets cleaned and disinfected daily __Yes __No
9. Are there tarp and notices in the site regarding health protocols __Yes __No
10. Are the supervisors and senior employees dead serious in having __Yes __No
the above observed
11. Are your interments properly noted and observed by the town __Yes __No
or city health office
12 Are number of relatives in interment limited to 10 only as per IATF __Yes __No
protocols?
13. Are number of payors visitors in the office limited to observe --Yes __No
social distancing?
14. Is money collected being handled properly? __Yes __No
(no touch, sanitized
14 Acquiring auto immunity:
1. Are you engaged in some form of exercise of 30 minutes or more __Yes __No
a. Individual __Yes __No
b. Corporate __Yes __No
2. Are you taking any or all of the following supplements?
Vitamin C __Yes __No
Vitamin D __Yes __No
Zinc __ Yes __No
naC __Yes __No
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