FRIENDLY MARITIME SERVICES, INC.

COVID-19 Signs and Symptoms Monitoring Worksheet for Joining Crew

Name of Crew: ____________________________________________________ Vessel: ___________________________

Address: ___________________________________________________________________________________________
Contact No. : _____________________________ Email Address: ______________________________________
Date of last exposure: ______________________
Date of departure: ________________________ Last date of monitoring: ______________________________
Instructions: Monitoring of temperature must be done twice daily, once in the morning and once in the evening, and report any
symptoms they are experiencing. For each day, document the morning and evening temperature and place an X in the box next to
each symptom that is experiencing. If the person is not experiencing any symptoms, place an X in the box labeled “No
symptoms”.
Day: Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Day 10 Day 11 Day 12 Day 13 Day 14

Date:

Time of check AM PM AM PM AM PM AM PM AM PM AM PM AM PM AM P AM PM AM PM AM PM AM PM AM PM AM PM
M

Temperature

Cough

Difficulty
breathing

Chest Pain

Diarrhea

Sore Throat

Others
(Specify)

No symptoms

Use additional monitoring sheet if necessary

_______________________ _____________________

TEMPERATURE MONITORING/REV.0/12 AUG 2020

Signature Over Printed Name Date Submitted

TEMPERATURE MONITORING/REV.0/12 AUG 2020