S/N	Place of contact	Date of contact	Time of contact	Designation	Full Name	Dept	Mobile	NRIC									Mask?			PPE				Contact Time							Distance from patient
																	in atZ	enQ. 2	| Surgical Mask |	| Gown |	| Gloves |	| Face Shield |	Goggles |	| <5 minutes |	| 5-10 minutes |	| 10-15 minutes |	| 15-20 minutes |	| 20-25 minutes |	| 25-30 minutes |	| >30 minutes |	Touched patient	1 m away	2 m away	3 m away	No contact but in the same room
1	W68	25/01/20	13:30	SSN	Tan xxxx xxxx			S	1	1	1	1	1	1	1	E	V			V	V											V

All information is submersible to MOH for contact tracing and accurate information you provide is greatly appreciate (Infection Prevention and Epidemiology) [x] Restricted, Sensitive (Normal)