【衛生保健組】學生-出國、國內熱門地點旅遊、接觸回國人員、居家隔離檢疫、自主健康管理調查表【Campus Health Services Section】 “Questionnaire for overseas and domestic travel history, exposure contact history, and home isolation/quarantine, self-health management” for Students

教育部臺教人(三)字第1090041383號，請同學自2020年4月1日起如有出國、4月1日至4月6日國內熱門地點旅遊、接觸回國人員、居家隔離檢疫、自主健康管理或發燒之狀況，請於4月7日下午五點前填寫相關旅遊史及接觸史等問卷資料供學校安排後續健康關懷措施。如因隱匿而造成校園防疫破口，將依校內獎懲規定追究其責任。請同學正確填寫並將本調查表回傳，俾利衛保組依同學狀況提供健康關懷與專業諮詢服務，若有相關疑問或防疫諮詢或協助，請聯繫臺北衛保組、桃園醫務室(02-28824564分機2224.3172)                                                                                                                                                                                                                                                                                                                                                                                                                                 學務處衛保組關心您

個資聲明個人資訊，將作為本校防疫業務聯絡，及衛生單位防疫之用。請據實填報，以利防疫，如有隱匿病情導致疫情擴散，將可能遭相關法規(傳染病防治法)追蹤刑責。

In compliance with the official document Tai-Chiao HR (3) No. 1090041383 of Ministry of Education, students are required to fill out the following questionnaire before 17:00 pm on April 7 regarding recent travel history and contact exposure history for the university to arrange follow-up health care measures for those who have been abroad after April 1, visited domestic popular tourist spots during April 1 to 6, have been exposed to anyone who has returned from overseas or has been undertaking home quarantine, self-health management or had a fever. Anyone who conceals any facts that results in a possible breach of campus Covid-19 prevention measures will be held accountable in accordance with MCU Merit and Demerit Procedures. Please fill out the questionnaire correctly and submit it for Campus Health Services Section to provide health care and professional counseling services. If you have any questions, please contact responsible staff of Campus Health Services Section on Taipei Campus or Taoyuan Campus Health Services through 02-2882-4564 Ext. 2224 or Ext. 3172

The personal information collected on this form is used for epidemic prevention liaison between the university and public hygiene entities. Please answer questions candidly to help with epidemic prevention. If any hidden case causes the epidemic to spread, you may be punished under relevant laws and regulations (Communicable Disease Control Act).