COVID-19 Daily Self-Screening Form
To help prevent the spread of COVID-19 and reduce the potential risk of exposure to our students and staff, we are conducting a simple screening questionnaire. When you arrive Chiang Rai, you're required to answer this questionaire for 14 days. Your participation is important to help us take precautionary measures to protect you and everyone in the university. Thank you for your time and co-operation.
Today's Date
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Day
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Month
Year
Date
Full Name
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Gender
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Please Select
Male
Female
Not willing to Disclose
Student ID
Mobile Phone Number
E-mail Address
example@example.com
Body temperature
Have you had any of the following symptoms in the last 24 hours?
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Yes
No
Cough
Shortness of breath of difficulty breathing
Responsiveness
Friendliness
OR at least TWO of the following symptoms in the last 24 hours:
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Yes
No
Fever (usually 100.4 or higher)
Chills
Repeated shaking with chills
Muscle pain
Headache
Sore throat
New loss of taste or smell
Please be noted that If you answered 'yes' to any of the questions above then you are required to avoid risk-prone areas or crowded places for no less than 14 days and
Please contact the Global Relations Division staff immediately, the following online platforms: LINE Official Account: @Global MFU /WeChat Official Account: @Global MFU /MFU Email: global@mfu.ac.th
I acknowledge the information that I have provided above is true and correct to the best of my knowledge.*
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