逢甲大學因應嚴重特殊傳染性肺炎防疫管理措施調查表
各位「本國籍並於2月11日至3月1日自中港澳入境或轉機」同學您好:

👉目前本校境外生(含中港澳籍)同學在入境臺灣後皆已進入「居家檢疫」或「自主健康管理」階段,為因應嚴重特殊傳染性肺炎(武漢肺炎)防疫管理措施,並配合中央流行疫情指揮中心及教育部之政策,敬請惠予填答下列表單,以利學校後續提供您健康關懷與諮詢,共同維護校園健康安全環境。

💕溫馨提醒:「勤洗手、保持室內通風、減少出入公共場所、外出配戴口罩」,如有身體不適、發燒、呼吸急促請戴口罩儘速就醫。若有疑問請與健康中心護理師聯繫(2546、2548)

🔒個資聲明:本表所蒐集之個人資訊,將作為本校防疫業務聯絡,及衛生單位防疫之用。
請據實填報,以利防疫,如有隱匿病情導致疫情擴散,將可能遭相關法律追究。

逢甲大學學務處關心您
您所就讀的系所 (例如:00系)(The Department of your major:) *
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您所就讀的年級/班級 (例如:二年/甲班)(The Grade/ Class:) *
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您的姓名:(Student Name:) *
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您的學號:(Student Number:)(D0000000) *
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您的聯絡電話:(Phone Number:) *
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入境或接觸史情形(Entry History:) *
請依照實際情形擇一勾選(Please select one according to the actual situation)
Required
本人回台或親友返台時間:(The Time of Entry: Including your relatives’ entry time. When will you/friends/relatives come back Taiwan?) *
MM/DD/YYYY
MM
/
DD
/
YYYY
啟程地:(Departure:) *
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您目前健康情形:(Current Health Condition) *
可複選(multiple choices)
Required
您或親友入境航班班次:(The Flight Number: Friends/ Relatives/ Your flight of arrival number)
非必填(You can leave it blank)
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其他問題或需要協助事項:(Additional questions or assistance you need:)
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