*1. 我的工號 Employee ID(ex. v00001)

*2. 我的填單原因 My reason
我的PCR陽性或經醫生判斷為確診 PCR-Positive for employee / Diagnosed by doctor
我的快篩結果是陽性 Rapid test-Positive for employee
我是 確診者的第一圈接觸者(與確診者同住、共餐、吸菸區吸菸且聊天) 且未注射滿3劑疫苗 Tier 1 of the confirmed case (Living together, eating together, smoking in smoking areas, and chatting). Didn't received three COVID vaccine doses
我是 確診者的第一圈接觸者(與確診者同住、共餐、吸菸區吸菸且聊天) 且已施打過3劑疫苗 Tier 1 of the confirmed case (Living together, eating together, smoking in smoking areas, and chatting). Received three COVID vaccine doses
我是 高風險人員(與確診者辦公室座位相鄰(五宮格) High-risk personnel: 1. Those who sit on the left, right, rear, left rear, and right rear of the PCR positive/rapid test positive employee seat (5 people in total).

3. 我的最新PCR採檢日期或經醫生判斷為確診日期 My PCR test date/The date that diagnosed by doctor

4. 我的快篩陽性日期 The date that rapid test-Positive for employee

5. 我接觸的確診者為 The confirmed case I was in contact with was 請選擇 Please choose 公司員工 VisEra employee 非公司員工 Not VisEra employee

補充說明(i.e跟確診的家人/朋友/廠商/客戶等…有接觸)(i.e contact with confirmed case, he/she is my family members/friends/manufacturers/customers, etc...)

6. 該位確診者的員工工號是 The employee ID of the confirmed case is(ex. v00001)

7. 我與確診者最後接觸日 The date of my last contact with the confirmed case

8. 確診者之確診日期 Diagnosis date of confirmed case

*9. 我的公司足跡(此資訊用於廠務消毒用)(i.e 新竹廠FAB 3F P1區域及TE休息室、中壢廠OFFICE 3樓及FAB 5F、龍潭廠Office 3F) My VisEra Footprint (i.e FAB01 FAB 3F P1 & TE Room , FAB02 OFFICE 3F & FAB 5F , FAB03 Office 3F)

10. 我有執行PCR檢測 I have performed a PCR test 請選擇 Please choose Y N

11. PCR篩檢日期 PCR test date

12. 我有收到政府隔離通知(如：電子隔離單或簡訊)，隔離時間為XXXX/XX/XX~ XXXX/XX/XX(門禁權限關閉時間以此為主) I have received a government quarantine notice (such as an electronic quarantine sheet or text message), and the quarantine time is XXXX/XX/XX~ XXXX/XX/XX

*若有任何資訊更新，我將立即填寫疫調回報表If there is any information update, I will fill out the VisEra Epidemic Investigation Form