Health Declaration Form

Date of entry in Saatchi House ^*

First Name ^*

Last Name ^*

Email Address ^*

For the purpose of upholding a safe working environment amid the COVID-19 crisis, ALL employees of Ace Saatchi & Saatchi / Make Technology, Inc., (including all third-party/agency personnel) must accomplish the following checklist prior returning to work physically at the office. Fulfilling this checklist is self-administered, but must be answered truthfully. Any misrepresentation may be ground for employee’s dismissal.

If any of the answers above is ‘YES’ you are not allowed to enter SAATCHI HOUSE. You will need to seek medical clearance before you can return to work.

I hereby authorize ACE SAATCHI & SAATCHI /MAKE TECHNOLOGY, INC. to collect and process the data indicated herein for the purpose of effecting control of the COVID-19 infection. I understand that my personal information is protected by RA 10173, Data Privacy Act of 2012, and that I am required by RA 11469, Bayanihan to Heal as One Act, to provide truthful information. I understand further that this form will be destroyed after 30 days from the date of accomplishment, following the National Archives of the Philippines protocol