Health Declaration Form

✰HEALTH DECLARATION FORM✰

In line with the Ministry of Health's guidelines, please fill in the online form to declare your travel history and to answer a simple health screening questionnaire.

All members need to have temperature checking before enter the shooting location.
All members required to wear mask and keep 1 metre (3 feet) distance. (Except the host / talent / Actor / Actress)
All production team need to sanitize hands before start shooting.
All members need to fill in the self declaration form.
Kindly practice safe social distancing during production shoot if necessary.
For safety measurement, not more than TEN (10) persons in production shoot area. (Such as Studio or any indoor production shoot)
The health & well-being of our workplace and production team member is our priority, therefore Tickle U Production reserves the right to deny entry for anyone who poses a health risk into our workspace.

* Indicates required field

FULL NAME *

NICR/Passport No. *

Gender *

Nationality *

Phone Number *

Email *

Body Temperature *

Have you been to any area or countries of COVID-19 as indicated by WHO over the past 14 days? *

Have you been in close contact with person suspected to have COVID-19? *

DECLARATION AND CONSENT

I hereby declare that the information given above is true and accurate and if the information is false, action can be taken against me.
I, the undersigned hereby agree, consent and authorize Tickle U Production to collect, use, process and store for the Malaysia local health agencies.

Submit

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Tel : 012 3416885 (Penang, MALAYSIA) Email: tickleuproduction@gmail.com
ADDRESS: Level 2, Moulmein Rise Shoppes, No. 9, Jalan Moulmein, Pulau Tikus, 10350 George Town, Pulau Pinang
   MALAYSIA Registration number: PG0336837-X
©2020 Tickle U Video Production