losis□□寄生性传染病Parasiticinfections□□2、你的任何一位家人是否有以上疾病?□□Hasanyclosefamilysufferedfromanyoftheabove?3、你或你周围的人是否曾遭受以下痛苦?□□Haveyouoranyclosecontactsufferedfromanyoffollowing?复发性严重的腹泻和呕吐Recurringseriousdiarrheaorvomiting□□复发性的皮肤病Recurringskintrouble□□复发性的疖子,睑腺炎或糜烂性手指Recurringboils,stiesorsepticfingers□□复发性的失聪,失明,龋齿Recurringdischargefromtheears,eyes,gums/mouth□□4、请具体给出任何其他医疗问题,这些问题可能会导致你不能进入食品类车间,例如,复发性的肠胃失调。Pleasegivedetailsofanyothermedicalproblemswhichmayeffectyouremploymentasafoodhandler,forexample,recurringgastrointestinaldisorder.□□5、最近三个月是否曾出国?Haveyoubeenabroadwithinthelast3months?□□如果有,哪里?Ifyes,where?注:进车间、出车间随身带有玻璃制品者(如眼镜等)是否完好□□ingoutoftheworkshop.……………………………………………………………………………………………………………我声明上述陈述均真实并尽我所知的完成此调查表。pletetothebestofmyknowledgeandbelief.签名Signature日期Date批准人Approvedby职位Position
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