07.2 CURSO EXTRANJEROS | CONTECON MANZANILLO SA DE CV SEG

COURSE

Personal Information

* Name

* Company

* Job post

Date of entry

* Official identification

Legible copy, valid credential and on both sides

* Insurance policy

* Blood type

* E-mail

* Country

* CMSA Contact

Safety training

Safety training

Clinical information

* Have you had these symptoms in the last 14 days?

Instructions: If you had symptoms, indicate the start and end date of the symptoms.

	Yes / No	Start date (MM/DD/YYYY)	End date (MM/DD/YYYY)
Fever
Cough
Loss of smell
Loss of taste
Flu
General discomfort

Attach the proof of COVID-19 vaccination

Comments

* The person who answers this questionnaire declares to have answered sincerely without having hidden any symptoms or relevant information that hinders the diagnosis of a suspected or confirmed patient

Yes, I accept