Epidemiological Survey on COVID-19

Please fill in the following information

Have you ever travelled to medium/high-risk areas or areas with reported cases in or outside China over the last 14 days?

Have you had any contact with people from medium/high-risk areas in or outside China over the last 14 days?

Have there been two or more cluster cases of fever and/or respiratory symptoms in your family, office, school, kindergarten, workshop and other collective units over the last 14 days?

I guarantee that the above information is true and correct, and I shall be held liable for any concealment.