國立中央大學-教職員工及學生『出入境通報問卷系統』 National Central University- the notification questionnaires system of departure and entry for the faculties, staffs, and students
為因應新型冠狀病毒防疫工作,惠請全校教職員工及學生出入境務必填報此問卷系統,以利校方掌控名單,安排健康管理相關措施,避免防疫破口。
注意:自109年3月2日開學日後入境台灣者,皆須填報。
防疫工作小組 敬上
In response to the epidemic prevention of the COVID-19, all the students, faculties, and the staffs must fill this questionnaire on their arrivals or departures. This will help us to know who are on the list and arrange necessary measures for health management to prevent the omission.

The epidemic prevention team - NCU.

PS: anyone who arraives after March 2, 2020 must fill this questionnaire and notify
姓名(Name) *
Your answer
身份別(Identity) *
單位/系所(Department) *
Your answer
學號(Student ID )
Your answer
出境國家(Country of departure) *
Your answer
入境台灣的日期(End Date of entry) *
MM
/
DD
/
YYYY
轉機地點(無轉機填『無』)Transfer location *
Your answer
檢疫情形(The situation of the quarantine) *
健康自主管理、居家檢疫、居家隔離開始日期(The starting date of the self-health management/ home quarantine/ home isolation)
MM
/
DD
/
YYYY
健康自主管理、居家檢疫、居家隔離結束日期(The ending date of the self-health management/ home quarantine/ home isolation)
MM
/
DD
/
YYYY
健康自主管理、居家檢疫、居家隔離期間-居住地點(The place of residence) *
聯絡電話(分機)extension number
Your answer
手機(Phone) *
Your answer
電子郵件(e-mail) *
Your answer
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