Students'DailyHealth Reporting 学生每日健康问卷（英文版）

Q1:I promise I will fill the bellowing form with true and accurate information and bear the correspondent responsibilities if I was covering up.填表人承诺以下填报内容属实，如有瞒报、漏报、迟报、谎报等，愿意承担相关法律责任。

Q2:What was the time when you are filling the form?进行筛查的时间？

Q3:Your Name：学生姓名

Q4:Your current temperature:您的体温

Q5:Did you or will you leave Beijing today?您今天有离开北京吗？

Q6:Your current location:您的当前所在地

Q7:Your co-resident(s) stay in Beijing today?今天学生的所有同住人在北京吗？

Q8:Do you or any of your co-resident(s) have the following symptoms？学生或共同居住人是否有以下症状发生？

Q9:In the past 14 days, have you or your co-resident(s) been in contact with persons who are back to Beijing from abroad ？在过去的14天内，学生或共同居住人是否接触过从境外来京人员？

Q10:In the past 14 days, have you or your co-resident(s) travelled from medium-risk or high-risk areas to Beijing?在过去的14天内，学生或共同居住人是否从国内中、高风险地区返京？

Q11:Do you have any visitors from other cities in China today?今天你的家庭中有京外人员到访吗？