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國立清華大學衛保組校園傳染病防治調查 NTHU Division of Health Service Survey on Epidemics
(1) 一般的環境：如桌椅、把手，消毒使用1：100的稀釋漂白水（500 ppm）。
(2) 浴室或馬桶表面：使用1：10的稀釋漂白水（5000 ppm）消毒。
1. In case your axillary temperature is above 37.5°C, or you have such symptoms including fever, respiratory symptoms, loss of taste and smell, or unexplained diarrhea, please repot your symptoms to the survey and Line mentioned above and immediately make contact with : Division of Health Service 03-5743000 (Office Hour Monday to Friday 8:00 AM-17:00 PM) or Student Assistance Division 03-5711814 (24 hours). We will have assistance to transfer you to the hospital. Please don’t discuss your status in public or any groups so as to protect yourself and keep it private. In addition, in case there is any unnecessary hurt after being diagnosed COVID-19 positive, your personal information will be fully protected.
2. To reduce the risk of pandemic outbreak, the Ministry of Education has regulated that the student who is under self-health management is not allowed to come to campus or present at crowded place. If you need to go out, you should wear medical masks at all times, wash your hands frequently, implement respiratory hygiene and cough etiquette and avoid group activities. If you need to eat, it is recommended that you take out and return to the self-health management location to eat. Pay attention to the hygiene habit of washing hands before meals. Individuals with fever or respiratory symptoms such as coughing or running nose are to wear a medical mask, seek medical attention immediately and not to use public transport; inform the physician of your contact and travel history, wearing a surgical mask while returning home and avoid going out, and keep 1 meter away from others when talking to them.
3. If you still feel uneasy or fearful, you can fill in the ‘Relief Prevention’ application form from the NTHU Counseling Center. The consultant will contact you and provide you short-term and supportive consultation according to your need. ‘Relief Prevention’ application form :
4. Suggestions for disinfection and environment hygiene:
a. Locations and places where the human body may contact frequently (such as conference room tables and chairs, tea rooms, saloons, etc.) should be sanitized with 1: 100 ratio bleach.
b. The toilet should be disinfected with a blend of washing powder and 1: 10 ratio bleach.
Division of Health Services wish you all well.
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填表原因The reason for filling in this questionnaire
新冠肺炎確診者Diagnosis of COVID-19
新冠肺炎確診者之密切接觸者Contact with a COVID-19 patient
醫生高度懷疑之社區型肺炎Highly concerning of communal pneumonia by the doctor
與新冠肺炎確診者足跡相同Having been the same venues with COVID-19 patient
有不適症狀(發燒、呼吸道症狀、嗅味覺異常或不明原因腹瀉) Feeling uncomfortable (Fever, Respiratory Symptoms, olfactory sensation or gustation malfunctioned, or diarrhea for unknown reasons)
有國內旅遊史Having domestic travel history
有國外旅遊史Having international travel history
體溫測量數值（℃) body temperature (℃)
學號／員工編號 student/faculty number
系所或單位 department or division
是否填過本表單 Have you ever finished this form?
第一次填報本表單，請按繼續鍵 No; this is my first time.
續報2-21天 Yes and correction of information is NOT needed.
續報2-21天，""需要""修改已填報資料 Yes and correction of information IS needed.
身體狀況 Physical status
我被診斷為新冠肺炎 Diagnosis of COVID-19
我被診斷為A或B流 Diagnosis of influenza A or B
我只是一般感冒(做快篩排除A或B流) Diagnosis of ordinary influenza
我只是一般感冒(沒做快篩) Influenza (no test)
我沒有不舒服症狀 No symptoms
服藥狀況 Medication status
服用克流感中 Taking Tamiflu
服用一般感冒藥中 Taking ordinary medicine for flu
服用抗病毒藥物中 Taking anti-virus medicine
沒生病，不需服藥 Healthy (no need for medication)
已康復，不需服藥 Recovered (no need for medication)
該服藥，但沒吃藥(感冒藥或克流感等) Should be medicated, but have not.
我目前住在哪裡? Where do I live currently?
我住在集中檢疫所 I live in Government Quarantine Facility
我住在防疫旅館 I live in quarantine hotel.
我住在醫院 I live in hospital.
我住學校宿舍 I live in the dorm.
我住學校隔離宿舍 I live in the quarantine room.
我住家裡 I live at home.
我住在校外宿舍 I live off campus.
我是否上學／上班? Do I go to school/ come to work?
有上學／上班 Yes, I will go to school/ come to work.
沒上學／上班 No, I won’t go to school/ come to work.
被通知居家檢疫第12-14天之PCR採檢日期You are arranged PCR test between the 12th day and 14th day of your quarantine period and write down that date.
被通知居家檢疫第12-14天之PCR採檢時間You are arranged PCR test between the 12th day and 14th day of your quarantine period and write down that time.
已完成自主健康管理第6-7天之居家快篩日期You can take a rapid home test between the 6th day and 7th day of your self-health management period and write down that date.
已完成自主健康管理第6-7天居家快篩結果Your rapid home test between the 6th day and 7th day of your self-health management period, please write down the result.
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