Instrumen Self Assessment Risiko COVID-19 (Student)
Jawablah pertanyaan-pertanyaan ini dengan JUJUR sesuai dengan kondisi Anda sekarang. Hal ini SANGAT PENTING bagi kesehatan dan keselamatan kita bersama di kampus SGU. Apabila Anda tidak menjawab dengan jujur maka akan ada konsekuensi yang harus Anda tanggung.

Please answer the following questions HONESTLY based on your current conditions. This is VERY IMPORTANT for our health and safety on SGU's campus. If you don't answer honestly, there will be consequences that you have to take.
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Email *
Nama / Name *
Student ID *
Tanggal / Date *
MM
/
DD
/
YYYY
Program Studi / Study Program *
Dalam 14 hari terakhir, apakah Anda pernah mengalami hal-hal berikut: / Have you experienced the following in the past 14 days:
1. Apakah Anda pernah mendatangi tempat umum dimana berkumpul banyak orang (pasar, fasyankes, kerumunan orang, dan lain-lain)? / Have you been to public places where there are large crowds? *
1 point
2. Apakah Anda pernah menggunakan transportasi umum? / Have you used public transport? *
1 point
3. Apakah Anda pernah melakukan perjalanan ke luar kota / ke luar negeri yang merupakan wilayah zona merah? (periksa status wilayah di https://covid19.go.id/peta-risiko) / Have you traveled to other cities / regions / countries that are categorized as red zone areas (check the status of the areas on https://covid19.go.id/peta-risiko)? *
1 point
4. Apakah Anda pernah mengikuti kegiatan yang melibatkan orang banyak? / Have you participated in activities involving a large crowd? *
1 point
5. Apakah Anda memiliki riwayat kontak erat dengan orang yang dinyatakan  sebagai ODP, PDP, atau kasus COVID-19 terkonfirmasi (berjabat tangan, berbicara, berada dalam satu ruangan / satu rumah)? / Have you been in close contacts with people determined as ODP, PDP, or confirmed cases of COVID-19 (shaking hand / talking / being in the same room / house)? *
5 points
6. Apakah Anda pernah mengalami demam / batuk / pilek / sakit tenggorokan / sesak napas? / Have you had fever / cough / runny nose / sore throat / difficulty of breathing? *
5 points
7. Apakah Anda memiliki riwayat penyakit komorbid atau sedang mengalami kondisi yang tertera dibawah ini? / Do you have a history of comorbid diseases or are currently experiencing the conditions listed below? *
5 points
Required
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