Student ID (If you are an employee, please specify your position) *
Your answer
Faculty/Division/Center/Institute *
Your answer
Mobile phone number *
Your answer
Emergency contact number (parent/relative) *
Your answer
Do you have any of these symptoms ? *
Required
Do you have a medical condition? *
Travel history report of 55th COVID-19 confirmed case in Chiang Mai
Travel history report of 56th COVID-19 confirmed case in Chiang Mai
Travel history report of 58th COVID-19 confirmed case in Chiang Mai
Travel history report of 61st COVID-19 confirmed case in Chiang Mai
Travel history report of 62nd COVID-19 confirmed case in Chiang Mai
Travel history report of 63rd COVID-19 confirmed case in Chiang Mai
Travel history report of 66th COVID-19 confirmed case in Chiang Mai
The area you traveled to (Please specify the place, date, and time in detail) *
Your answer
Have you been tested for COVID-19? *
Address in Chiang Mai Province: *
Your answer
Please describe your current accommodation situation. Do you live in a private or shared room/apartment with a bathroom? Does the property have elderly residents or residents with hereditary diseases? Are you currently self-isolating? *
Your answer
Have you registered in the CMU SELF CHECK FOR COVID-19 yet? (Where you are asked to provide your daily health report for 14 days) *
QR Code to register for health assessment in CMU SELF HEALTH CHECK FOR COVID-19 (if the questions are only in Thai, please use Google to auto-translate).