Port Entry Crew Health Status Declaration Sheet
Vessel Name
Port of Arrival
Date of Arrival
Flag
IMO/MMSI No.
Agent
Crew Health Status
No.
Crew Name
Rank/Position
Nationality
Date of Birth
Temperature (°C)
Symptoms (Fever, Cough, etc.)
Remarks
Declaration
I hereby declare that the above information is correct and complete to the best of my knowledge.
Master's Name:
Signature:
Date: