Tokyo Campus Entry Record
Please submit this Tokyo Campus Entry Record as a part of measures against the spread of COVID-19 upon entering the Tokyo Campus, University of Tsukuba.

Please be sure to contact us immediately if you test positive for COVID-19 within three days after leaving the Tokyo Campus., Tel: 03-3942-6918, Fax: 03-3942-6824

If you set a spam email filtering, please make sure that you can get an auto-reply email from gmail.

<Personal Information Handling>
We will not use personal information which we collect from this form except for keeping entry record in relation to COVID-19. We will make sure to take active measures of safety by appointing a management representative in order to avoid the risks such as loss and leakage, etc.
Email address *
Record upon Entry
Please fill out the followings upon entering the Tokyo Campus.
Name *
Affiliciation *
If you choose "others", please specify your affiliation.
Phone Number
Have you recently tested positive for COVID-19? *
In the last 14 days, have you had relatively slight cold symptoms, lasting a few days, including fever and cough, or severe symptoms including shortness of breath, excessive fatigue, and high fever? *
Purpose of Entry ex) : attend a seminar, research at the library, etc. *
Date *
Entry Time *
When entering the Tokyo Campus, please fill in the all of the fields above. After completing them, please go to the next page leaving the fields unanswered, and submit this form. You will get an auto-reply email so please show it to a security guard at the main entrance for approval of entry. When leaving the Tokyo Campus, please click "回答を編集(Edit)" on that auto-reply email to go on to fill out the second page and resubmit it. Please remember to show the auto-reply email, which is sent to you upon your second submission, to a security guard at the main entrance before leaving.
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