JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
文藻外語大學教職員工COVID-19疫苗接種情況調查Survey on COVID-19 vaccination status
各位老師、同仁，大家好！
為維護校園安全，訂定合宜之防疫措施，敬請各位填報您COVID-19疫苗接種情況，謝謝！
人事室敬上111.2.18
Sign in to Google
to save your progress.
Learn more
* Indicates required question
1、單位Department
*
Your answer
2、姓名Name
*
Your answer
3、職編Staff No.
*
Your answer
4、請問您是否施打過COVID-19疫苗？Have you ever been vaccinated against COVID-19?
*
是；請續填第5~9題 Yes. Please continue to fill in Q.5~Q.9.
否；已預約；請跳填第10~11題 Booked. Please fill in Q. 10~Q.11.
否；問卷填答結束 No. Questionnaire completed.
5、請問完成COVID-19疫苗接種第幾劑？What is the dose of COVID-19 vaccination?
第1劑；請續填第6~7題 The first dose. Please continue to fill in Q.6~Q.7.
第2劑；請續填第6~9題 The second dose. Please continue to fill in Q.6~Q.9.
第3劑；請續填第6~11題 The third dose. Please continue to fill in Q.6~Q.11.
Clear selection
6、請問接種COVID-19疫苗第1劑廠牌？The brand of the first dose of COVID-19 vaccine
AZ
莫德納Moderna
BNT
高端MVC
Other:
Clear selection
7、請問接種COVID-19疫苗第1劑日期？The date of the first dose of the COVID-19 vaccine
MM
/
DD
/
YYYY
8、請問接種COVID-19疫苗第2劑廠牌？The brand of the second dose of COVID-19 vaccine
AZ
莫德納Moderna
BNT
高端MVC
Other:
Clear selection
9、請問接種COVID-19疫苗第2劑日期？The date of the second dose of the COVID-19 vaccine
MM
/
DD
/
YYYY
10、請問接種COVID-19疫苗第3劑廠牌？The brand of the third dose of COVID-19 vaccine
AZ
莫德納Moderna
BNT
高端MVC
其他
11、請問接種COVID-19疫苗第3劑日期？The date of the third dose of the COVID-19 vaccine
MM
/
DD
/
YYYY
12、請問預約接種COVID-19疫苗廠牌為何？The brand of the COVID-19 vaccine appointment
AZ
莫德納Moderna
BNT
高端MVC
Other:
13、請問預約接種COVID-19疫苗日期？The appointment date for COVID-19 vaccination
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of 文藻外語大學.
Report Abuse
Forms
