Infection Control Agreement

Infection Control Agreement for COVID-19

(To be completed by each donor)

Due to the severe situation of the pandemic novel coronavirus (COVID-19), we are following the guidelines from the World Health Organization (WHO) to ensure that the samples we receive are not infectious.
When collecting or supplying a sample for our test, please tick and ensure the requirements below are met:

Name *

Email *

Date *

Have you travelled overseas or to any regions affected by COVID-19 within the past 14 days? *

Yes No

Have you had any contact with anyone affected by COVID-19 or showing flu-like symptoms within the past 14 days? *

Yes No

Have you presented any flu-like symptoms such as fever, fatigue, dry cough, diarrhea, etc. within the past 14 days? *

Yes No

Our partner laboratories have the right NOT to conduct testing if they or the sample collector suspects that the samples provided by the donor may be infectious *

I agree and provide truthful information about my current health condition, travel and contact history within past two weeks (14 days)

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Infection Control Agreement for COVID-19

(To be completed by each donor)