Purpose of this template: information to be recorded by the crew prior to departure to confirm their COVID-19 health status and to facilitate processing by government health authorities. Notwithstanding the completion of this card, a crew member may be subject to additional examination by the health authorities as part of a multi-layered preventive approach, e.g. if the recorded temperature is 38°C or higher.
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Covid-19 | Health Status before Departure Crew Member
In the past 14 days, have you had close contact (face to face within one meter and for more than 15 minutes or direct physical contact) with anyone who had symptoms suggestive of COVID-19?
Have you had any of the following symptoms in the last 14 days?
Temperature at start of work
Temperature is not recorded because the person does not feel/appear feverish
Temperature in degrees Celsius
Datum & Uhrzeit
Haben Sie in den letzten 14 Tagen einen positiven COVID-19-Test erhalten?
Crew member Identification
Airline / aircraft operator:
Nationality and Passport No:
Datum & Uhrzeit:
Please note that this checklist template is a hypothetical example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
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