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["新型コロナウイルス感染症（COVID-19)に関する健康状態記録表（教職員用）"]
["症状がある方はもちろん症状がない方も日々記録し、ご自身の健康状態を把握しましょう。万が一感染者あるいは濃厚接触者となった時、保健所の調査に役立てることができます。"]
["所属キャンパス",null,null,"教職員区分",null,"所属部局",null,null,null,null,"勤務員番号",null,"氏名"]
[]
["日付",null,"月　　日",null,"月　　日",null,"月　　日",null,"月　　日",null,"月　　日",null,"月　　日",null,"月　　日"]
["時間：体温","朝","：","．　　℃","：","．　　℃","：","．　　℃","：","．　　℃","：","．　　℃","：","．　　℃","：","．　　℃"]
[null,"晩","：","．　　℃","：","．　　℃","：","．　　℃","：","．　　℃","：","．　　℃","：","．　　℃","：","．　　℃"]
["　　【症状】\n\n該当症状の\nチェックボックス\nにレ点を入れる"]
[]
["　【行動履歴】\n\n（例）\n出勤\n会議\n（15時～16時）\nテレワーク\n自宅待機等"]
[]
["日付",null,"月　　日",null,"月　　日",null,"月　　日",null,"月　　日",null,"月　　日",null,"月　　日",null,"月　　日"]
["時間：体温","朝","：","．　　℃","：","．　　℃","：","．　　℃","：","．　　℃","：","．　　℃","：","．　　℃","：","．　　℃"]
[null,"晩","：","．　　℃","：","．　　℃","：","．　　℃","：","．　　℃","：","．　　℃","：","．　　℃","：","．　　℃"]
["　　【症状】\n\n該当症状の\nチェックボックス\nにレ点を入れる"]
[]
["　【行動履歴】\n\n（例）\n出勤\n会議\n（15時～16時）\nテレワーク\n自宅待機等"]
["\n"]
["【罹患状況】"]
[]
["【受診状況】",null,null,null,null,null,"受診日：","月　　　日",null,"病院名：",null,null,null,null,"検査：\n（PCR法）"]
[]
["【渡航および接触歴等】　"]
[null,null,null,null,null,"国名：",null,null,null,null,null,null,"期間：","月　　　日","～","月　　　日"]
[]
[null,null,null,null,null,null,null,null,"対象者：",null,null,null,null,"時期：","月　　　日　頃"]
[]
[null,null,null,null,null,null,"イベント・ライブ名\nカラオケボックス等",null,null,null,null,null,null,"開催日：","月　　　日"]

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["検査（PCR法）","所属キャンパス","教職員区分","学生区分","学部/研究科","学年"]
[]
["受けていない","市ヶ谷","専任教員","学部生","法学部",1]
["陽性","多摩","兼任教員","大学院生","文学部",2]
["陰性","小金井","専任職員","学部特別学生","経済学部",3]
[null,null,"嘱託職員","大学院特別学生","社会学部",4]
[null,null,"臨時職員","通信教育部生","経営学部"]
[null,null,"派遣職員",null,"国際文化学部"]
[null,null,"委託業者",null,"人間環境学部"]
[null,null,"その他",null,"現代福祉学部"]
[null,null,"\n\n\n\n\n\n\n\n",null,"情報科学部"]
[null,null,null,null,"キャリアデザイン学部"]
[null,null,null,null,"デザイン工学部"]
[null,null,null,null,"理工学部"]
[null,null,null,null,"生命科学部"]
[null,null,null,null,"グローバル教育学部"]
[null,null,null,null,"スポーツ健康科学部"]
[null,null,null,null,"人文科学研究科"]
[null,null,null,null,"国際文化研究科"]
[null,null,null,null,"経済学研究科"]
[null,null,null,null,"法学研究科"]
[null,null,null,null,"政治学研究科"]
[null,null,null,null,"社会学研究科"]
[null,null,null,null,"経営学研究科"]
[null,null,null,null,"工学研究科"]
[null,null,null,null,"人間社会研究科"]
[null,null,null,null,"情報科学研究科"]
[null,null,null,null,"政策創造研究科"]
[null,null,null,null,"デザイン工学研究科"]
[null,null,null,null,"キャリアデザイン学研究科"]
[null,null,null,null,"公共政策研究科"]
[null,null,null,null,"理工学研究科"]
[null,null,null,null,"スポーツ健康学研究科"]
[null,null,null,null,"法務研究科"]
[null,null,null,null,"イノベーション・マネジメント研究科"]
[null,null,null,null,"その他"]