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112年covid-19確診通報
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依據教育部指示,因應 COVID-19 疫情,學校仍應掌握校內教職生確診情形,敬請您協助填寫以下資料。本資料依據個資法蒐集、處理及利用您的個人資料包含識別個人姓名、行動電話等。上述個人資料之蒐集、處理及利用,將僅限防疫需要使用,並遵守個資法之規定妥善保護個人資訊。
開南大學防疫小組敬啟
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姓名(Name)
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學號(student ID)(非學生填教師或職員)
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系別(Department)(單位)
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年班級(例-三A)(grade)(非學生填無)
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手機號碼(phone number)
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國籍
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快篩陽性日
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MM
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DD
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YYYY
就醫(或視訊)醫療院所名稱
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是否住宿舍(dormitory)
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宿舍房號(一宿or二宿+房號)(dormitory number )
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室友名字(住宿或租賃處-室友是本校才填,沒有就填無)
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