Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
學童感染疑似傳染病週報表
新泰國小健康中心
Sign in to Google
to save your progress.
Learn more
* Indicates required question
年級
*
Choose
1
2
3
4
5
6
幼稚園
選項 1
Clear selection
選項 1
Clear selection
班級
*
Choose
1
2
3
4
5
座號
Choose
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
姓名
Your answer
疾病
類流感(突然發燒38度C及呼吸道感染,且有肌肉酸痛或頭痛或極度厭倦感其中一項ˋ症狀)
腸病毒
腹瀉(每日腹瀉三次以上，且合併以下任何一項以上症狀::嘔吐.發燒.黏液壯或血絲.水瀉)
水痘
發燒(耳溫38度C)且未有上述疾病或症狀
紅眼症
其它(上述六種項目外之特殊傳染病)
COVID-19確診
週一(0:無、A:生病仍上課、B:生病在家休息、C:住院)
0
A
B
C
Clear selection
週二(0:無、A:生病仍上課、B:生病在家休息、C:住院)
0
A
B
C
Clear selection
週三(0:無、A:生病仍上課、B:生病在家休息、C:住院)
0
A
B
C
Clear selection
週四(0:無、A:生病仍上課、B:生病在家休息、C:住院)
0
A
B
C
Clear selection
週五(0:無、A:生病仍上課、B:生病在家休息、C:住院)
0
A
B
C
Clear selection
週六(0:無、A:生病仍上課、B:生病在家休息、C:住院)
0
A
B
C
本週無符合通報個案
不需通報
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
