SELF-DECLARATION FORM

For your information:

Before departure:
Valid test methods on the test taken less than 24 hours before departure are the standard PCR-based analysis or the
rapid antigen-based test. The documentation must be issued in Norwegian, Danish, Swedish, English, French or
German.

To prove positive result for COVID-19 (corona)

To prove a positive result, it is only the PCR-based analysis that is approved. Self-declaration from your doctor
without the PCR-based analysis it not good enough as documentation.

3
1. Have you previously tested positive for COVID-19 (corona)?
YES
NO

If yes, you must send valid documentation on the PCR-based analysis to your manager.
(From receiving the results of a positive coronavirus test, it must be a minimum of 2 weeks before
departure. The coronavirus test you should have taken 24 hours before departure lapses. (Remember to
bring the valid documentation with you, if you do not, you might be refused entry).

2. I confirm that I will send valid documentation on the PCR-based analysis to my manager
YES
NO

3. I confirm that I have not had any presence with anyone who has been infected with COVID-19 (corona)
the last 14 days.
YES
NO

4. I am symptom free and have been symptom free for the last 14 days.
YES
NO

5. I have taken an approved PCR-based analysis or the rapid antigen-based test for COVID-19 (corona),
with negative result taken less than 24 hours before departure. (If you do not present documentation of a
valid negative test result when arriving Norway, you might be refused entry).
YES
NO

6. Please attach the valid PCR-based analysis or rapid antigen-based test for COVID-19, also remember
to bring the documentation with you.

7. I confirm that I have given the correct information

YES
NO

In the event of dishonest answers, you will not be allowed to travel to Norway and work-, or if it gets revealed after
arriving Norway, you will be sent home on your own expense.
Place / date: _________________________________

Signature: ___________________________________