2022.04.09起,為保障所有入住旅客安全,入住時於櫃檯須配合填寫紙本健康說明書,內容如下。
配合政府防疫政策,請您誠實回答下述項目:
For epidemic prevention, please fill in and submit this form accurately.
1. 請問您或他人(含同住者、同行者)近期 14 天內有出入境哪些國家/地區(含轉機)? 若您選擇「其他」請說明您到訪過的國家/地區。Have you (including co-residents, visitors) visited or transited any countries in the past 14 days? If you select "Other", please reply to the country you visited. 1...顯示更多2022.04.09起,為保障所有入住旅客安全,入住時於櫃檯須配合填寫紙本健康說明書,內容如下。
配合政府防疫政策,請您誠實回答下述項目:
For epidemic prevention, please fill in and submit this form accurately.
1. 請問您或他人(含同住者、同行者)近期 14 天內有出入境哪些國家/地區(含轉機)? 若您選擇「其他」請說明您到訪過的國家/地區。Have you (including co-residents, visitors) visited or transited any countries in the past 14 days? If you select "Other", please reply to the country you visited. 1
否 No
其他Other:¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬________________________________________________________
2. 請問您或他人(含同住者、同行者)是否有發燒(高於或等於 37.5°C)、呼吸道症狀、咳嗽喉嚨痛、全身無力等類似嚴重特殊性傳染性肺炎症狀? Are you (including co-residents, visitors) having symptoms such as fever (equal or higher than 37.5 degree Celsius), shortness of breath, difficulty in breathing, cough, sore throat, extremely fatigue, muscle ache?
否 No
是 Yes
3. 請問您或他人(含同住者、同行者) 是否接獲「自主健康管理通知書」、「居家隔離通知書」、「旅客入境健康聲明暨居家檢疫通知書」? Have you (including co-residents, visitors) received the Notice on Self-Management of Health or Home-Isolation /Home Quarantine Notice?
否 No
是 Yes
※ 如有規避妨礙、填寫不實者,將依傳染病防治法第 58 條及同法第 69 條提報相關主管機關處理。 According to articles 58 and 69 of the Communicable Disease Control Acts, all are required to accurately report his/her travel history without any concealment. Any person who refuses, evades or obstructs abovementioned measures would be reported to governmental authorities.
※ 若因隱匿居家檢疫事實或違反相關事項導致旅宿損失,本旅宿將保留法律追訴權。 Once any violation of quarantine or related regulation results in losses of the hotel, ZENGIN Hotel will reserve the right to pursue legal action.
※ 防疫期間依規定禁止群聚,入住期間禁止吵鬧喧嘩,本旅宿已善盡宣導責任,若因附近民眾檢舉確有違反規定情事並經主關機關開罰,旅客將自行負擔相關法律責任及罰則。 During the epidemic prevention period, gatherings are prohibited in accordance with regulations, and loud noise is prohibited during the stay. ZENGIN hotel has done its best to promote the regulations, the passenger will bear the relevant legal responsibilities and penalties.
4. 本人已閱畢並且同意上述之說明。I certify that I have read the information above and will cooperate with ZENGIN Hotel.
同意 Agree
不同意 Disagree
5. 若您非本國籍人,請選擇 "其他" 並說明國籍。If you are not of Taiwanese nationality, please select "Other" and reply your nationality.
是 Yes
其他:______________________________________________________________
6. 姓名 Name
_____________________________________________________________________
7. 身分證字號或護照號碼 ID Number/Passport Number
_____________________________________________________________________
8. 電話 Telephone Number
¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬_____________________________________________________________________
9. 入住日期 Arrival Date
西元 年 月 日