Safe Entry Form

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Safe Entry Form

姓名 Name *

身份证号码 ID number *

目的 Purpose *

录影 Video Recording

办公室工作 Office work

Other:

日期 Date *

YYYY

登入时间 Check-in time *

Time

体温 Body temperature *

过去14天有出国吗？ Travelled overseas in the past 14 days? *

有 Yes

没有 No

是否有收到居家隔离的指示，或因呼吸道感染而获得病假？ Received a quarantine or isolation order, stay-home notice, or been issued medical certificates for respiratory symptoms? *

有 Yes

没有 No

是否有接触过确诊患者？A close contact who is a confirmed case? *

有 Yes

没有 No

登出时间 Check-out time *

Time

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