國立高雄科技大學新冠肺炎回報聯絡單   NKUST  Report form for COVID-19
您好：
Dear Students, Faculty, and Staff,
一、因應國內本土疫情變化，若您快篩陽性，須「自主健康管理」時，請主動填寫本表單，以利本校掌握疫情現況。
If your COVID-19 test is postive,  please fill in the survey so that school could report to MOE(Ministry of Education).
二、通報聯絡電話：
       (一)學務處衛保組07-3814526#12531-12534(建工)、18535(燕巢)、22086-22089(楠梓)、25085(旗津)、 31251-31255(第一)(服務時間：週一至週五08:00-17:00)
       (二)校安中心專線：0800-550-995
       學務處關心您
If you have any questions, concerns,   please contact OIA directly.
       Tell: 07-3814526 #19032
       Email: qaoffice01@nkust.edu.tw

       *必填 / "*" required questions.  
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1.校區Campus *
2.身份別Identity *
3.系所班級/單位Department/Office
(學生請註明班級，如:進修半導體二甲、觀光一乙)
 *
4.職編/學號Student/Employee ID No. *
5.姓名 Name *
6.性別 (校安通報需要) Gender (For report to MOE) *
7. 民國出生年(校安通報所需)Birth Year (For report to MOE) *
8.聯絡手機Mobile Number  *
9.電子信箱 mail *
11.您目前自主健康管理地址？Please leave your current address during self-health management. *
12.若您為學校宿舍住宿生，請填寫住宿樓名及寢室號碼(如 南海樓101-1) Please leave your room number if you live at school dorms.
13. 請問您哪一天快篩陽性?   
What date did you test postive?
MM
/
DD
/
YYYY
14. 若您有看診，請問幫您看診的醫療院所名稱(如: 安心診所) Which medical institution diagnosed for you? 
15.請問您的症狀有哪些?Please describe your symptoms. *
16.其他(狀況描述或需協助事項)Any assistance you need from us (please describe in detail).
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