Request edit access
MyNewNorm
Contactless Information
Sign in to Google to save your progress. Learn more
Your name: *
Your temperature number (degree celcius): *
Your contact number: *
Check-in date:
MM
/
DD
/
YYYY
Check-out date:
MM
/
DD
/
YYYY
In the last 14 days, have you: *
1. Been exhibiting any COVID-19 symptoms (fever, cough, shortness of breath, sore throat)
In the last 14 days, have you: *
2. Had close contact with COVID-19 positive patient?
I hereby acknowledge that the information given in this form is correct and accurate. *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy