帰国者/入国者の方へ For returnees/entrants
※病院勤務者及び病院実習中の学生は附属病院の指示に従ってください
※People who works at hospitals, or are in hospital practice should follow the instructions of the hospitals.
下記をコピー、項目内容を記載し総合安全衛生管理機構 ナース室まで
まずはメールにてご連絡ください。
Please Copy and paste the following information to the nurseroom of the Safety and Health Organization, Chiba University.
Please contact us by e-mail first.
| Reason | Returnees/Entrants |
| Today's Date | Year/Month/Date |
| Faculty Departmet | Where you belongs |
| Staff/Student ID Number | 8 digits of numbers and alphabets |
| Category | Staff or Student |
| Name | Name |
| Body temperature | current ℃（usual ℃） |
| Contact | Telehone E-mail address |
| Any contact with Covid19 positive person | yes/no If yes, is the person in Chiba University? |
| Overseas history | Which country ( ) |
| Date of Returnees/Entrants | year/month/date |
| Pending period | year/month/date thru year/month/date |
| self-isolation/quarantine place | hotes/home Where（Chiba-city, etc.） |
| Living | Alone / With Family or Roommate / Dormitory |
| Covid19 vaccination | vaccinated / not vaccinated |
| 1st dose | year/date/month （Vaccine name：Pfizer/Modena/others, etc. ） |
| 2nd dose | year/date/month （Vaccine name：Pfizer/Modena/others, etc. ） |
| 3rd dose | year/date/month （Vaccine name：Pfizer/Modena/others, etc. ） |
| Free space | Any allergies, etc. |
ナース室 Nurseroom
Email: info-hsc（@）office.chiba-u.jp / Please change （@）to @
Tel: 043-290-2214