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1、来部人员防疫信息申报表Health Information Form for MFA Visitors参会日期Date: 2020年11月11日9:00媒体机构名称Media Organization参会人员姓名Name记者类型（文字/摄影/摄像/其他,请注明）Type(text/photo/camera/other,please specify)记者证件号码/旁听证件号码Press Card #手机号Cell#有无发烧、咳嗽、乏力等症状Any symptoms of fever, cough, weakness?近14天内，是否有国内其他城市旅行史？如有，注明城市、旅行时间及城市风险等级In
2、 the past 14 days, have you travelled to other cities of China? If yes, please specify the city and date of travel and the COVID-19 risk level of the city.近14天内，是否有国外旅行史？如有，注明国家及旅行时间In the past 14 days, have you travelled to other countries? If yes, specify the country and date of travel.与确诊病人、疑似人员接
3、触或同乘交通工具情况Any contact with those confirmed or suspected with COVID-19 in public transportation?共同居住的家属是否存在上述情况Does any of your relatives living with you have any of the above experience?本人认为需要说明的其他相关情况Do you have other experience that you deem necessary to declare? If yes, please specify.本人签字Signature