Business Government

Create an Online Health Declaration Form for your Business and Improve the Process

The Philippine government requires businesses that will operate at limited capacity to have a Health Declaration Form to be filled-up by both employees and customers upon entry. With the use of technology we can ensure a safer and possibly a more convenient process.

One of the requirements from the Philippines’ IATF and government departments like DTI, DOT, etc. is that businesses that will start to operate at the allowable minimum capacity should have a Health Declaration Form that will primarily aid in contact tracing, should *knock on wood, anything happen related to COVID-19.

Sure we can photocopy these forms but we should also keep in mind we need to reduce the chances of contact, ensure the privacy of information submitted, and take into account a process that may be more convenient (depending on the business).

I plan on setting up a kiosk, using a Tablet, to facilitate the entry for this. I also want to make a sign with a QR code and link to the form so those queuing can already fill it up on their own phones. In such way, it also saves me on paper, helps the queue, and allows me to limit the disinfection objects .

Which is why I’ve setup an online health declaration form that can be used by businesses for both their staff and their customers.

I based this off the Health Declaration Forms used by the House of Representatives and Malaca├▒an Palace.

Get Started

I made the form using JotForm, an online form tool. It is free up to a certain number of submissions. You are free to search alternative form providers but what I like about this service is that it makes it easy to sign-off the form plus has the option of encrypting responses.

The encryption capability gives an extra level of security on the side of the business and helps to ease the mind of the customer, that the submitted data is solely for the use of health related guidelines as required by law.

  1. Sign-up with JotForm here and create a free account.

2. Proceed to Templates > Form Templates

3. Search for “Health Declaration Form

4. Click on “Use Template

5. Customize it with your branding, information, including details on the company and e-mail address for contact.

6. Check the Form Settings and you may choose to Encrypt form data, then also set the email address where the responses will be set. Customize further to your liking.

7. Publish the form and get your form link. This will be the website address to set in your kiosk when you have customers fill-up the form.

Tip! Use a URL shortener service like to shorten your form link. You can setup signs in your establishment to instruct customers to go to that link and fill-up the form with their own mobile phones.

Further, you can also generate your own QR code and place it in a sign for customers to use.


Should you be using a kiosk or computer aided setup, ensure you remember to do the following:

  • Regular disinfection of the tablet screen or mouse and keyboard.
  • Ensure physical distancing is observed as a queue will be expected when you require clients to fill-up this form upon entry.
  • Be patient, and calm when letting customers understand why we need to do this.

Thank you and I hope this works for you! Please share this to fellow people in business who may find this helpful ­čÖé