表二:
“接送流浪孩子回家”专项行动受助未成年人基本信息月表
填报单位(盖章): 统计起止日期: 年 月 日- 年 月 日 单位:人次
| 性别
| 年龄
| 身体状况
| 救助时状态
| 离家外出的原因
|
男
| 女
| 0-2岁
| 3-6岁
| 7-12岁
| 13-15岁
| 16-18岁
| 健康
| 危重
病人
| 残疾
| 独自一人
| 与父母一起
| 与其他成年人一起
| 其他
| 被拐
| 外出打工
| 逃学离家
| 与家人吵架
| 盲目外出
| 其他
|
视力
残疾
| 听力语言残疾
| 智力
残疾
| 肢体
残疾
| 精神
残疾
| 多重
残疾
|
栏
| 20
| 21
| 22
| 23
| 24
| 25
| 26
| 27
| 28
| 29
| 30
| 32
| 33
| 34
| 35
| 36
| 37
| 38
| 39
| 40
| 41
| 42
| 43
| 44
| 45
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市站
| (1)
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其中:儿保二班
| (2)
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黄浦站
| (3)
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卢湾
| (4)
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徐汇站
| (5)
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长宁站
| (6)
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静安站
| (7)
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普陀站
| (8)
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闸北站
| (9)
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虹口站
| (10)
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杨浦站
| (11)
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闵行站
| (12)
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宝山站
| (13)
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嘉定站
| (14)
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浦东站
| (15)
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金山站
| (16)
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松江站
| (17)
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青浦站
| (18)
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奉贤站
| (19)
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崇明站
| (20)
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全市合计
| (21)
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