Request edit access
政治大學學生清明連假期間國內旅遊史調查表 Spring Break Travel History Form
親愛的同學,您好:
為降低防疫風險及後續疫情調查所需,請您於4月8日下午3時前登錄連假期間的旅遊軌跡.若您在春假期間若有去過中央防疫小組警示的11處地點者(墾丁、阿里山森林遊樂區、花蓮東大門夜市、嘉義文化路、台南關子嶺、虎頭埤、烏山頭水庫風景區、高雄興達港、旗山老街、雲林北港朝天宮等),請主動做旅遊史申報,並自主健康管理14天,在自主健康管理期間請全程戴口罩。如有症狀請戴口罩就醫,請勿到校。本次調查資料處理將依個人基本資料保護法規定辦理,謝謝您的配合!
                                                                                             政治大學關心您的健康
Dear students,
If you have visited the following 11 locations warned by The Central Epidemic Command Center
(CECC) during the spring break (Kenting, Alishan Forest Recreation Area, Hualien
Dongdamen Night Market, Chiayi Cultural Road, Tainan Guanziling, Hutoupi, Wushantou
Reservoir Scenic Area, Kaohsiung Xing Da Harbor, Qishan Old Street, Yunlin Beigang
Chaotian Temple), please take the initiative to make a travel history declaration and conduct 14 days of self-health management. Please wear a mask during this period of time. If you have symptoms, please  wear a mask and go to a doctor and do not come to our campus.

                                                                                              NCCU cares about your well-being
Sign in to Google to save your progress. Learn more
姓名Name *
學號Student ID number *
請問您目前是否在台灣?或在境外?Are you currently in Taiwan or overseas *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy