Name *

(as per HKID or Passport)

First Name

Last Name

Have you returned to and/or arrived in Hong Kong in the past 14 days? *

Yes

No

Have you been in contact with any person who has returned to and/or arrived in Hong Kong in the past 14 days? *

Yes

No

Have you been in contact and/or live with any person with confirmed or a probable case of COVID-19 in the past 14 days? *

Yes

No

Have you displayed and/or experiencing any of the following symptoms: *

Fever

Dry Cough

Shortness of breath

Loss of taste and smell

Less related symptoms: headaches, aches and pains, sore throat and fatigue

No symptoms

Have you been to any location and/or facilities with confirmed/probable cases of Covid-19 in the past 14 days? *

Yes

No