[FOR INTERNAL USE]
Temperature Tracking Form
This form is for internal tracking purposes only. There is no need to
submit to MOM
Employers are advised to check and monitor closely the health condition of employees who had
been in China for 14 days upon returning to Singapore.
Temperature checks should be made twice a day for 14 days upon returning to Singapore. Please
advise employees to seek medical attention promptly if they feel exhibit fever and respiratory
symptoms (cough, shortness of breath, runny nose, sore throat).
Name of Employee:
_______________________________________________________
Department:
_______________________________________________________
Day
No.
1
2
3
4
5
6
7
8
9
10
11
12
Date
Time
Period
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
Temperature Recorded
13
14
PM
AM
PM
AM
PM
Employee’s Signature:
_______________________________________________________
Date (DD/MM/YY):
_______________________________________________________
For more details, please visit www.mom.gov.sg/wuhanvirus
*This form is used for tracking the temperature of employee who had been in China for 14 days upon
returning to Singapore The information should not be used for any other purposes.