Current location and travel history for Communication Engineering Students 2020-02-06

*1.

Class

Communication Engineering 161
Communication Engineering 171
Communication Engineering 181
Communication Engineering 191

*2.

Student Number

*3.

Name

*4.

Do you have a cold, fever, respiratory symptoms?

Yes. Please contact your advisor.
No. Good, but no symptom does not mean no virus. A few cases show the otherwise, so everybody needs to be careful.

*5.

What is the phone number to reach you for urgent matters?

*6.

All communities in Hangzhou are doing thorough check with all residents and property owners. What is your registered address in Hangzhou? Please include room number. For example:
1. off-campus address registered with the police, e.g. Hanmoxianglin 34-3-602
2. on-campus dorm address: Donghe / Tingsong building No. - Room No., e.g. Donghe 4-205

*7.

Where do you live now? Please fill in the detailed current address so that suitable suggestions and assistance can be provided to you accordingly.

on campus
outside campus in Hangzhou. If the current address is different from the registered address, please notify the current landlord and register, otherwise he/she may be penalized and evict the illegal tenant.
back home to my own country
in Hubei Province/Wenzhou/Taizhou
in other city of China (not in above-mentioned areas)
in other country

*8.

Please fill in the detailed current address so that suitable suggestions and assistance can be provided to you accordingly.
1. on campus, e.g. Donghe 4-205
2. outside campus in Hangzhou, e.g. Hanmoxianglin 5-1-502.
3. back home to my own country, fill in the city and scheduled return date and flight, e.g. Bandung Indonesia 2020.02.23 MU546
4. in Hubei Province/Wenzhou/Taizhou, fill in the detailed address, e.g. Wenzhou Lucheng area Yanger road Rujia Hotel room 905
5. in other city of China (not in above-mentioned areas), fill in the detailed address, e.g. Shanghai Lucheng area Yanger road Rujia Hotel room 905
6. in other country, fill in the country and city, e.g. Bandung Indonesia

*9.

During the winter vacation, have you travelled outside Hangzhou, including trip to return home? Some train pass by areas with high risk but you may not be familiar with the places. With provided information, we can search if you were on the same vehicle or premises with confirmed patients and advise you accordingly.

Yes. Please find the ticket or record. This is very important, even if it was more than 2 weeks ago.
No

*10.

What was the date of your first travel?

*11.

What was the mode of travel? (Multiple Choice) 【多选题】

*12.

The Vessel Number:

From (city/station) to (city/station)

*13.

Is there a second trip or return trip?

Yes
No

*14.

What was the date of the second/return trip？

*15.

What was the mode of travel for the second/return trip?（Multiple Choice）【多选题】

*16.

The Vessel Number:

From (city/station) to (city/station)

*17.

Within the last 3 weeks, have you been in contact with anyone from Hubei province/Wenzhou/Taizhou (Zhejiang) or who has travelled to these areas or any suspected novel coronavirus case?

Yes and who and his/her contact *
No

18.

Do you know any classmate or friend nearby with symptoms or travel history that concerns you?

*19.

What difficulty do you have in handling the current situation? Do you have any feedback or suggestion to us?

Thank you for filling in the form. If there are more than 2 travels or you remember more travel details in the future, please fill in again.

Please follow carefully official information, e.g. messages from IES staff and posts from IES wechat subscription account ies2014. Follow the suggestions closely to stay safe and take good care of yourself.