Health Condition Check Form

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Health Condition Check Form

Please measure your body temperature and answer following questions everyday. If you develop symptoms of COVID-19, immediately inform your supervisor and FSSU.

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* 表示必填問題

Name *

您的回答

Date *

MM

/

DD

/

YYYY

1. Do you have a fever over 37.5 degrees Celsius? *

Yes

No

2. Do you feel sick? *

Yes

No

If you answer "yes" to the question 2, please write your symptoms here.

您的回答

提交

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