Vessel Crew COVID-19 Daily Health Self-Assessment Form
Crew Member Name
Crew ID
Date
Symptoms Check
Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Loss of taste or smell
Sore throat
Muscle or body aches
Headache
Nausea or vomiting
Diarrhea
Temperature (°C)
Exposure History
Close contact with a confirmed COVID-19 case in the past 14 days
Traveled in areas with high COVID-19 cases in the past 14 days
Remarks
Signature
Date