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疫情專題
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對于4-22狀況的調(diào)查表

發(fā)布時間:2020-04-28 12:28:32 分類:其它

作者:在線調(diào)查 來源:jfshbx.cn

Daily report of prevention of novel coronavirus pneumonia
歡迎幫我們回答問卷,這是我們畢業(yè)前實習(xí)調(diào)查設(shè)計,不討論對錯,請放心填寫,謝謝。

Q1. 請問您的性別是?(單選題)

    Q2. 您的年齡大概是多少?(單選題)

      Q3. 您的職業(yè)是?(單選題)

        Q4. Name(填空題)

          Q5. Current Location(填空題)

            Q6. Has your location changed today?(單選題)

            • Yes

            • No

            Q7. Do you return to Shanghai today?(單選題)

            • Yes

            • No

            Q8. Your Destination(填空題)

              Q9. Departure(填空題)

                Q10. When and how did you leave Shanghai?(填空題)

                  Q11. When and how do you return to Shanghai?(填空題)

                    Q12. Your address in Shanghai(填空題)

                      Q13. Note(填空題)

                        Q14. Do you have any health problems today?(單選題)

                        • Yes

                        • No

                        Q15. Personal statement(填空題)

                          Q16. Do your family members or roommates living with you have any health problems today?(單選題)

                          • Yes

                          • No

                          Q17. Personal statement(填空題)

                            Q18. Have you or your family members living with you returned from abroad countries?(單選題)

                            • Yes

                            • No

                            Q19. Personal statement(填空題)

                              為了開展此次問卷調(diào)查,請各位積極踴躍的參與。謝謝大家的支持與捧場!

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