PREMISES COMPLIANCE REPORT
FOR CATEGORY 3

(CAT-3)

The Category that you chose is :-

Category 3 - Premises with Frequent Presence of Covaval-21

Understandings of Category 3 :-

The Premises that you went to had some Visitors or Customers who are not complying to MOH's
Regulations or Orders and no intentions to obey the rules at all.
They don't have any initiative or efforts in taking part of complying to what the MOH has ordered
or even to support the front-liners who are currently very tired in fighting off the pandemic.

IMPORTANT NOTES :-
1) Ensure everything were filled in properly.
2) Your Contributed Information shall be Legit and your Report shall included with Photographic Evidence.
3) Thank you for Cooperating with us!

Full Name*

Phone No. (Whatsapp)*

Email Address*

You agree to mention that this premise are having customers/visitors that got problems with their compliances towards MOH regulations and orders?*
1) Have you made any report to MOH so far?*

2) Have you made any calls to Police 993 so far?*

3) First of all, the Covaval Person is a Male or Female?*

4) Age most likely around... *

5) Did they Scanned the Bruhealth's QR Code with their phone?*

6) Did they wear any Face Masks while entering the Premise?*

7) is there any interventions being made after you saw or met this person?*

8) Is there any interventions being made by someone else?*

9) What are his feedbacks after being intervened?*

The Premise's Name*

Type of Premises*

The Location or Address of the Premise?*

Any Photographic Evidence to support this report? (Picture of the person, Picture of Entrance or The Shop's Banner or Logo)*

PREMISES COMPLIANCE REPORTFOR CATEGORY 3

(CAT-3)

PREMISES COMPLIANCE REPORT
FOR CATEGORY 3