Annex 1

Pre-boarding questionnaire for Crew members

The questionnaire is to be completed by all crew prior to embarkation.
The pre-boarding screening has the purpose to identify possible increased risk within the
boarding crew and defer the embarkation until favourable condition is met (Those answering
yes on any of the questions below)
Name as shown in the passport: Date:
_______________________________ .

Contact number: .
Are you fully vaccinated (both doses if applicable + 14 days) Yes No
Vaccine documentation to be provided to master upon boarding.

Within the past 3 days and to the best of your knowledge

Questions YES/NO
Have you had close contact with anyone diagnosed as having
coronavirus disease (COVID-19)?

"Close contacts" mean people who have been in close contact with
a person with confirmed COVID-19 disease from 48 hours before
symptom onset and until that person comes out of isolation.

Close contacts
 Indoors: closer than 2 metres for more than 15 minutes
continuously with a person with confirmed COVID-19
disease.
 Outdoors: closer than 2 metres for more than 15 minutes
continuously, face-to-face, with a person with confirmed
COVID-19 disease.
 Have been in direct physical contact with (e.g. shake hands)
with a person with confirmed COVID-19 disease.
Have you had any respiratory tract symptoms or fever the past 5
days?

I have read, understood and answered truthfully to the best of my ability? Yes
I have read and understood the attached travel advice? Yes
All forms to be sent to onboard vessel prior sign on date.

Master:
Any forms with a question(s) answered Yes (excluding confirmation of reading/vaccination
status) must be sent to crewing coordinator.
 Annex 1
Pre-boarding questionnaire for Crew members

Travel Advice
Dear All,
As you are now preparing for a travel, we wish to remind you all, the importance that travel is
carried out as safely as possible, mitigating risk of exposure during this period.
If you have trouble getting a hold of face masks and alcohol-based hand disinfectant, before
your travel, please contact your Crew Coordinator to check if this can be sent from your
Crewing office. Please request as early as possible, enabling time for postage.
The face mask is intended for use during public and other transports, at airports and other
places where social distancing cannot be maintained. Always clean hands before putting on
facemask and after removing facemask. When wearing mask ensure it covers mouth and
nose, try not to touch or adjust once in place. Regularly replace disposable facemasks.
The alcohol-based rub is to be used when it not possible to wash your hands with soap and
water.
The best means to avoid becoming infected with COVID-19, continues with the simple steps
of good hygiene and social distance, this guidance is also applicable to fully vaccinated
crewmembers
 Maintain a strict hand hygiene by frequently washing your hands or by using hand
sanitizers where soap and water is not available.
 Practice cough/sneeze etiquette to prevent spraying droplets and do not invade
colleagues’ personal space 1.5 mtr when this is possible
 Maintain a high level of hygiene by showering and changing clothes frequently.
 Maintain social distance when travelling in a group
 If you develop any COVID-19 symptoms, inform vessel and Crew Coordinator. Use a
Face mask when not isolated.
The risks of Covid-19 infection in fully vaccinated people cannot be completely excluded
where community transmission of the virus is widespread. Vaccinated people can still
become infected and spread the virus to others, potentially unvaccinated crewmembers.
If you have been in close contact with suspected or confirmed cases stay extra
vigilant and monitor for symptoms the next 10 days.
Notify crew coordinator if you get this information during your travel onboard, if/when
this occurs, daily antigen test to be taken the next 5 days.

Quarantine guidance:
 Any stopovers requiring overnight stays or when awaiting to embark a vessel,
all crewmembers are recommended to follow travel advice to minimize chance
of infection.
 Actively seek information and stay updated on any legal requirements and quarantine
regulations enforced by the given Country you are in.
When arriving an area where Quarantine is applicable by law or company guidelines, please
strictly adhere to the communicated and established guidelines. Breaking quarantine
regulation can have great impact on crew change plans, and in worst case also severe legal
consequences. Please contact the local representative when in doubt.

We wish you all safe travel!