JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
桃園市移工快篩專案-快篩回報
針對桃園市境內移工人數20-49人快篩專案
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
企業名稱
*
公司全銜
Your answer
快篩日期
*
如有多日，分開填寫
Your answer
篩檢地點
*
地址
Your answer
篩檢人數
*
請填寫數字，其他文字免輸入
Your answer
快篩情形-陰性人數
*
請填寫數字，其他文字免輸入
Your answer
快篩情形-陽性人數
*
請填寫數字，其他文字免輸入
Your answer
PCR結果
*
如有快篩陽性，請至醫院診所做PCR，並再次回復此表單
Your answer
連絡人
*
Your answer
聯絡電話
*
Your answer
備註
其他未作篩檢的原因
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
