疫情信息登记表

你的姓名（eg. Sofia Zhou）

Your name （eg. Sofia Zhou）

手机号

Mobile phone number

身份证号码

ID Number

家庭住址

Home address

是否接到疾控中心的流调电话

Did you receive an epidemiological survey call from Shanghai Municipal Center for Disease Control & Prevention?

是否曾到过中高风险地区？如有，请填写具体地址。

Have you ever been to medium-risk regions or high-risk regions？If yes，please fill in details.

请填写今日在远洋商业大厦的行动轨迹。（例如：18/F、长江会议室、厕所、星巴克等）

Please fill in your movement track in the building today. (Such as 18/F, Conference Room Changjiang, Toilet , Starbucks, etc)