[PDF] HEALTH DECLARATION FORM - Freightlink PDF dfds_covid-19_health

DFDS Ferry (Immingham) HEALTH DECLARATION FORM – COVID-19 INTERIM MEASURE We are collecting personal data of visitors to our properties for the

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DFDS Ferry (Immingham) HEALTH DECLARATION FORM ʹ COVID-19 INTERIM MEASURE We are collecting personal data of visitors to our properties for the purposes of enabling us to carry out contact tracing and other response measures, in response to any emergency that may arise due to 2019-novel Coronavirus (COVID-19) that may threaten the life, health or safety of other individuals. The information will be destroyed once there are no business and legal purposes to keep them. We have the right to refuse entry to any persons who are unwell, who have been to locations of public health concern in the past 14 days or who have been in contact with any person with a confirmed case of the coronavirus.

Contact Information:

Full Name Mobile:

DFDS site to be visited: Scheduled date of arrival:

Please indicate if you are:

DFDS staff Visitor (Company name:

Health Wellbeing and Recent Travel History

1. Have you been in contact with any person who is a confirmed case of COVID-19 in

the past 14 days? YES NO

2. Do you currently have a fever or any flu like symptoms such as persistent cough,

runny nose or sore throat? YES NO A Temperature check may be administered by crew after you have boarded the vessel and if a fever of 38C or higher is detected the Vessel Master reserves the right to refuse you passage. In these circumstances you would then have to disembark. By signing below you are consenting both to this check, and also that you will comply, and co- operate with any instructions issued by the vessel Master.

Acknowledgement

I have answered all questions to the best of my knowledge. I acknowledge and agree to the collection, use and disclosure of my personal data, health information and recent travel history for the purposes set out in this Form.

Signature: Date:

For DFDS use only: I have checked the above declaration and the visitor is clear to visit this site.

Print: Signed: Date:

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