from any of the above? 你的任何一位家人是否有遭受到以上疾病? □□ 3.Have you or any close contact suffered from any of the following? 你和你接触的人是否曾遭受以下痛苦? □□ Recurring serious diarrhoea or vomiting 复发性严重的腹泻和呕吐□□ Recurring skin trouble 复发性的皮肤病□□ Recurring bolls , sites or septic fingers 、 sties 复发性的疥子或糜烂性手指□□ Recurring discharge from the ears, eyes, gums 复发性的失聪,失明或龋齿/ 口中□□ 4.Please give details of any other medical problems which may affect your employment asa food handler , for example, recurring gastrointestinal disorder. 请具体给出任何其它医疗问题,这些问题可能会影响你成为一个合格前仪器类员工,例如,复发性的肠胃失调□□ 5.Have you been abroad within the last 3 months? 最近三个月是否曾经出国? □□ If Yes, Where? 如有,哪里? I declare that all foregoing statements are true plete to the best of my knowledge and belief. 我声明上述陈述均真实并尽我所知的完成此调查表 Signed Date: Approved by: 填写人日期: 批准人:
全文预览
