【請填寫】14日(3月5日起)內入境教職員工生管理紀錄表 Documentation for NTNU Students/Faculty/Staff Arriving from China/Hong Kong/Macau/Korea
您好，為因應「嚴重特殊傳染性肺炎」（武漢肺炎）疫情，本校十分關心您的健康，為了提供您最好的後續照顧，請近１４天(3月5日起_內入境者，請協助我們填寫下列資料:
Dear faculty, staff, and students,
In light of the outbreak of 2019 Novel Coronavirus (2019-nCoV) in China, NTNU is concerned about the health of our faculty, staff, and students and would be more than willing to provide further assistance if needed. If you have been to China/Hong Kong/Macau/Korea and/or have transferred flights through China/Hong Kong/Macau/Korea to Taiwan, please fill in the following information. Thank you.
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未命名標題
姓名 Full Name *
類別 Role *
身份別
性別 Gender *
生理性別 Biological gender
聯絡電話 Contact phone number *
手機號碼 Cellphone number
入境時間 Arrival Date *
從中港澳韓入境 From China/Hong Kong/Macau/Korea
MM
/
DD
/
YYYY
管理措施_自主管理開始時間 Start Date for Self-Health Management *
MM
/
DD
/
YYYY
管理措施_自主管理結束時間 End Date for Self-Health Management *
MM
/
DD
/
YYYY
所屬單位或系所 Department or Institute *
EmaiI *
是否有發燒（額溫 ≧37.5℃、耳溫 ≧38℃）或急性呼吸道感染症狀 Have you had a fever (forehead temperature ≧ 37.5 ℃, ear temperature ≧ 38 ℃) or symptoms of acute respiratory infection? *
現居位置 Current Accomodation *
Required
旅遊地/僑居地 Places you've been to since 2020/1/20: *
Required
備註 Notes
提醒：請續填健康關懷問卷。Reminder: Please also fill in the NTNU 2019-nCoV Survey via the link below.
https://forms.gle/ECRmgc27vvxRuSBx7
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