Port Esbjerg Health Declaration 1 Start 2 Complete Is there or has there during the international voyage been any cases on board which you suspect to be of an infectious nature? * Yes No If yes, please state particulars * If yes, are there/were there Covid-19 symptoms? * Yes No Has the total number of ill persons during the voyage been larger than normal/expected? * Yes No If yes, please state the number of ill persons * If yes, please state particulars * Are there any ill persons on board now? * Yes No If yes, are there Covid-19 symptoms? * Yes No Are you aware of any condition on board which may lead to infection or spread of disease? * Yes No If yes, please state particulars * Within the last 30 days: Have persons on board been in close contact with persons or animals that have tested positive for Covid-19 within the last 30 days? * Yes No When did it happen? * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202220232024 Which measures were taken on board the vessel? * Note: The master should regard the following, typical Covid-19 symptoms* as reason for suspecting the existence of a disease of an infectious nature:• Dry cough • Sore throat • High temperature • Headache • Shortness of breath • Muscle pain *Symptoms defined by the Danish Health Authority I hereby declare that the particulars and answers to the questions given in this Declaration of Health are true and correct to the best of my knowledge and belief Name of ship or inland navigation vessel * Registration/IMO No * (Nationality)(Flag of vessel) * Arriving from * sailing to Esbjerg, DK Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202220232024 Signed Master * Email
