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文藻華語中心COVID-19「居家隔離」個案主動通報系統 (Home Isolation Report System )
111年5月8日起，居家隔離僅限同住家人（同寢室室友）。
From 8 May 2022, home isolation is restricted to family members living together (or roommates).
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* Indicates required question
Email
*
Your email
身份別
*
Identity
學生 Student
教師 Teacher
職員 Staff
職編/學號
*
Staff/Student ID number
Your answer
姓名
*
Name
Your answer
身份證字號/護照號碼/居留證號碼
*
ID/Passport/ARC Number
Your answer
國籍
*
Nationality
Your answer
手機號碼
*
Phone Number
Your answer
出生日期
*
Birthday
MM
/
DD
/
YYYY
原住宿地點（宿舍、住家地址或租屋處地址）
*
Resident Address
Your answer
接觸者身份與關係
*
Relationship
同住家人 Household member
宿舍室友 Roommate
您與確診個案最後接觸日
*
Latest contact date with comfirmed case
MM
/
DD
/
YYYY
接觸地點 (住家、宿舍或其他)
*
Location where the contact takes place (At home, dormitary, or others)
Your answer
居家隔離告知日期
*
When did you receive the home isolation notice?
MM
/
DD
/
YYYY
開始隔離日期
*
Date quarantine started
MM
/
DD
/
YYYY
隔離地址
*
Quarantine address
Your answer
疫苗施打情形
*
How many doses of COVID-19 vaccine did you get
無施打疫苗 (Never)
施打1劑疫苗 (One dose)
施打2劑疫苗 (Two doses)
施打3劑疫苗 (3 doses)
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