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Fillable Form Health Declaration

A Health Declaration Form is used for the initial medical assessment of an individual. It helps determine if a person is experiencing some symptoms or has been exposed to the virus.

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What is a Health Declaration form?

A Health Declaration form is a document used in the entry and exit screening procedures in public transportations, establishments, and other entities.

Traveling amidst the pandemic can be risky as Coronavirus disease or COVID-19 continuously spreads between people. Thus, the Health Declaration form is implemented as one of the health protocols of health authorities to help mitigate the spread of the virus.

An individual must accomplish a Health Declaration form before entering an establishment. Also, in local and international airlines, passengers need to furnish a Health Declaration form before departing at their destination to prevent transporting an infectious disease to other countries.

How to fill out a Health Declaration form?


Enter your temperature.


Enter the date.


Enter your name.


Mark the appropriate box for your sex. You can mark Male or Female.


Enter your home address.

Contact #

Enter your contact number.


Enter your email.

Are you experiencing:

Sore Throat

Mark Yes if you are experiencing a sore throat. Mark No, if not.

Body Pain

Mark Yes if you are experiencing body pain. Mark No, if not.


Mark Yes if you are experiencing a headache. Mark No, if not.

Fever for the past few days

Mark Yes if you are experiencing fever for the past few days. Mark No, if not.

Have you worked together or stayed in the same close environment of a confirmed COVID-19 case?

Mark Yes if you have worked together or stayed in the same close environment of a confirmed COVID-19 case. Mark No, if not.

Have you had contact with anyone with fever, cough, colds, and sore throat in the past 2 weeks?

Mark Yes if you have had contact with anyone with fever, cough, colds, and sore throat in the past two weeks. Mark No, if not.

Have you travelled to any place aside from your home?

Mark Yes if you have traveled to any place aside from your home. Mark No, if not.

What is the purpose of a Health Declaration form?

Individuals must bring their Health Declaration form when traveling and upon arriving at their destination. This is to verify that they are neither a confirmed, probable, nor suspected COVID-19 carrier.

It is imperative to be honest in answering the questions in the Health Declaration form so authorities can conduct necessary measures, including isolation and a 14-day quarantine.

What is Isolation?

In medical contexts, isolation is a preventive measure wherein a patient is isolated in a facility to contain a virus he or she has and prevent it from transmitting to other individuals.

If a person shows significant symptoms of COVID-19, he or she must be isolated in a COVID-19 facility to prevent the transmission of the virus.

What is Quarantine?

Quarantine is a COVID-19 preventive measure wherein a person considered as a close contact with a COVID-19 patient is required to quarantine within 14 days. It is followed to prevent the virus from transmitting to other people in case the person suspected to have the virus has become a carrier of the virus.

If a traveler is considered a potential case, he or she must undergo a 14-day quarantine at home or a COVID-19 quarantine facility.

What is a close contact?

A close contact is a person who has been exposed to a confirmed COVID-19 patient. Exposure may mean:

  1. Face-to-face contact with a COVID-19 patient within 1 meter for more than 15 minutes;
  2. Living in a house or sharing accommodations with a COVID-19 patient;
  3. Direct care for a COVID-19 patient without proper preventive measures; or
  4. Sitting within two seats apart from a COVID-19 patient in public transportation.

Someone who had close contact with an asymptomatic COVID-19 patient up to 24 hours before they tested positive is considered a close contact.

What to do if you are a close contact?

If you plan to travel but have had exposure to a COVID-19 case, you must first quarantine for 14 days. Until you test negative, avoid having contact with other people. Follow the COVID-19 safety precautions such as physical distancing, disinfecting, and proper wearing of masks.

Effectiveness of using a Health Declaration Form

Many public transportations conduct thermal scanning to reinforce the accuracy of the information provided in the Health Declaration form. An accomplished Health Declaration form may look convincing, but there is a possibility that passengers may have been exposed to the virus on their way to their destination.

If a passenger is detected with an above-normal temperature, he or she will be given time to isolate or the trip will be postponed until he or she tests negative for the virus. Also, the health authorities may conduct an isolated interview with the passenger for contact tracing. They will get information about his or her whereabouts before arriving at the travel station.

The use of the Health Declaration form in public transportations is essential in obtaining a successful contact tracing. It contains the passenger’s data to help the contact tracing team locate the other individuals who were exposed to the virus.

What is Contact Tracing?

Contact Tracing is the process of interrupting chains of COVID-19 transmission through identifying, listing, and following up on possible close contacts and confirmed patients.

The instrument used in Contact Tracing is called a Contact Tracing form. It helps track down people and the areas that are at risk of COVID-19.

Entry and Exit Procedures in Airlines

The risk in air travel has increased with several cases of COVID-19 that have been detected through entry screening at airports.

As a response to the danger of COVID-19, many airlines are adapting a new procedure to greet arriving and departing passengers.

Departing passengers are required to:

  1. Furnish a Health Declaration form;
  2. Undergo the first fever check upon arrival through COVID-19 safety websites and applications or physical check-in;
  3. Undergo the second fever check before entering the security area;
  4. Follow the mask declaration to customs before entering the security check. Some airlines require limits in bringing masks onboard;
  5. Undergo the third fever checking before boarding the aircraft; and
  6. Follow the distancing of seats on board.

Arriving passengers are required to:

  1. Furnish Health Declaration and Travel Record Declaration forms;
  2. Undergo a fever check at the airport’s arriving area;
  3. Install the recommended self-diagnosis application and check the “emergency contact” option; and
  4. Follow the designated route for the overseas passengers to exit the premises.


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