健康申報表 HEALTH DECLARATION FORM

甲部 Part A:

閣下在過去24小時內是否有以下任何症狀? Do you have any of the following symptoms in the past 24 hours?

發燒 Fever, 發冷 Chills & Rigor, 咳嗽 Cough, 喉嚨痛 Sore Throat,肚瀉 Diarrhoea, 呼吸困難 Shortness of Breath / Difficulty in Breath

乙部 Part B:

1. 閣下在過去21天內是否曾到訪香港以外地方?
Have you traveled outside Hong Kong in the past 21 days?

2. 閣下是否現正接受衞生署的強制檢疫(家居或其他住所)安排?
Are you currently under the compulsory quarantine (home or other accommodation) order by the Department of Health?

3. 閣下是否在過去 21 天內曾與 2019 冠狀病毒病確診個案及╱或疑似個案的患者有密切接觸?
Have you been in close contact with confirmed case(s) and/or preliminarily tested positive case(s) COVID-19 in the past 21 days?

* 如於甲部或乙部題目中有任何一項為「是」者，該人士將禁止進入比賽場地。
If any answer is “Yes” in Part A or Part B, then the visitor will not be allowed to enter to the match venue.

** 任何人士必須在進入比賽場地前提交健康申報表，否則將被禁上進入比賽場地。
All visitors must submit a health declaration form before entering the match venue, otherwise they will not be allowed to enter to the match venue.

*** 已填寫網上健康申報表人士，需要在進場前提供聯絡電話與足球總會工作人員核實資料方可進入比賽場地
Every person who have already filled in the online health declaration form is requested to provide the contact number to verify the information before entering the match venue.

聲明及注意事項 Declaration and Notice:

本人聲明據本人所知及所信，以上資料均屬正確無誤，並同意香港足球總會根據其資料保密守則(紀律守則第十八段)處理及使用本人所提供資料。
I confirm that the above information is accurate to my best knowledge and agree that such information will be processed and used in accordance with the HKFA’s Code of Confidentiality of Information (Code of Conduct Paragraph 18).

所收集的資料僅為確保安全及健康，有關資料將於到訪日期起31天後銷毀。
The information collected will only be used to ensure the safety and health and will be destroyed 31 days after the date of visit.