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個人健康申報表 / Health Declaration Form
The relevant Personal Information Collection Statement is available here.
Questions marked with a * are required
姓名 / Name *
部門 / Department
學生或職員編號 / Student or Staff ID
電話號碼 / Telephone No.
電郵地址 / E-mail
過去14日內曾否離開香港? / Have you travelled outside Hong Kong in the last 14 days? *
過去14日內曾離開香港到過的國家和城市? / Where outside Hong Kong have you been to in the last 14 days?
你回到香港的日期? / When did you return to Hong Kong?
你是否有以下的病徵? / Do you have any of the following symptom(s)? 
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