Covid-19 Test Result Declaration Form

Note:
As part of MCAS’s effort to ensure the safety of our community, all persons entering MCAS premises must perform an ART/PCR test.

Please fill up this form ONLY AFTER you have completed your ART.

Check your email and show the approval to Security / Screening Officer at our entrance. You are required to strictly adhere to prevailing MOH protocols and instructions of our Screening Officers and Staff at MCAS Entrance.

USE & RETENTION OF DATA
Data submitted will be kept for 30 days and strictly for processing of gaining entry to MCAS premise and may be provided to the authorities for contact tracing upon request.

Are you *

• Staff / Part Timer / SCO
• Exco / Council / Volunteer / Member / Student / Others
• Others i.e. Vendor, Auditor, Contractor

Division *Choose your divisionCorporate AffairsFinanceEducationDa'wahConvert's Care & Social ServicesDACCnDAYSScreening OfficerPart TimersRegular ContractorOthers

If Others – state your company name

Full Name (Per NRIC/Passport/FIN): *

Phone *

Email *

Date of test *

Entry Date *

As part of MCAS’s regular testing, all staff/vendor/cleaner/SCO must take Self Swab Covid-19 ART and submit it before leaving their home on the first work day of your workweek. If you are not rostered to come for the week, choose Friday of the current week. If you are not clear, please check with CA staff.

Date / Time of Entry to MCAS

Date

Time

Must be within hours of the ART test

Purpose of Entry

• Working / Meeting
• Classes / Bookshop / Appointments
• Others (Please specify)

Purpose of Entry

ART Result: *

• I have done the ART and the result is NEGATIVE.
• I have done the ART and the result is POSITIVE.
• I am exempted from ART testing.

Upload your negative ART kit showing only your name and date. DO NOT UPLOAD WITH YOUR NRIC/FIN/Passport

Click or drag a file to this area to upload.

.pdf, .jpg, .png, .jpeg, .doc – Max file size 2MB

Declaration: (NEGATIVE)

• I have done the ART and the result is NEGATIVE, and I confirmed the following: I am not tested positive for Covid-19 (either ART/PCR) in the last 72 hours. I am NOT subjected to any MOH quarantine or any other order.
• I will not enter any MCAS premises or participate in any on-location assignment if I have tested ART positive in the last 72 hours or if I am subjected to any MOH quarantine or other isolation order.
• All information provided are true, complete and accurate and I allow the information provided in this form to be used for health and safety purposes.

Reason for exemption:

• I am on the Government’s Fast and Easy Testing (FET-ESSS/QTC / RRT) Regime and the result is negative
• Exempted by MOH (please upload exemption letter below)
• Medically excused by doctor (please upload exemption letter below)

Upload your ART Test kit showing only your name and date. DO NOT UPLOAD WITH YOUR NRIC/FIN/Passport. If you are exempted by MOH or have a doctor letter, please upload it too

Click or drag files to this area to upload. You can upload up to 2 files.

.pdf, .jpg, .png, .jpeg, .doc – Max files size 4MB

Declaration: (POSITIVE)

• I have done the ART and the result is positive, and I confirmed the following: I am aware that I have to comply with prevailing MOH protocol and to self-isolate. I will not to enter any MCAS premises or participate in any on-location assignment until I have obtained a subsequent negative ART test (taken at least 72 hours later). All information provided are true, complete and accurate and I allow the information provided in this form to be used for health and safety purposes.

Declaration: (EXEMPTED)

• I understand that my application will now be processed manually by MCAS and I will not enter MCAS until I receive approval from MCAS Corporate Affairs Office. I confirmed the following: I am NOT subjected to any MOH quarantine or any other isolation order. I will not enter any MCAS premises or participate in any on-location assignment if I am subjected to any MOH quarantine or isolation order. All information provided are true, complete and accurate and I allow the information provided in this form to be used for health and safety purposes.

Submit