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Registration Form of ‘Students/Staff Returning from Other Provinces, Cities and Regions to Shanghai’

Sex
Male
Female
You have just returned from
A-Hubei Province
B-Wenzhou, Taizhou, Ningbo, Fuyang, Bengbu, Anqing, Liu’an, Haozhou, Nanyang, Xinyang, Zhumadian, Shenzhen, Yueyang, Shaoyang, Jiujiang, Xinyu, Shangrao, Yichun, Suzhou
C-Others, except for A or B
Residence Address in Shanghai
    ____________
I have had a closed contact with a confirmed COVID-19 case.
Yes
No
The information above is filled by
    ____________
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