Cruise Ship Guest Illness and Injury Report Form

Shipboard report form for documenting guest illness and injury incidents, including symptom onset, location, treatment provided, and mandatory reporting determination for VSP and port health authorities.

Submission Notice

• What happens after I submit?
• Submission type
• Your role

Guest and Incident Overview

• Date of incident
• Approximate time of incident
• Incident type
• Location of incident
• Location details
  Provide deck number, venue name, or other specific location details if needed.

Guest Information

• Guest name
  Optional unless needed for internal follow-up or reporting.
• Cabin number
• Guest age group
• Travel party size

Illness Details

• Symptom onset date
• Approximate symptom onset time
• Symptoms observed
• Possible exposure source
• Illness notes
  Include only clinically relevant observations needed for response and reporting.

Injury Details

• How did the injury occur?
• Body area affected
• Injury severity
• Injury notes

Treatment and Response

• Was the medical center visited?
• Treatment provided
• Treatment details
  Include only the minimum necessary treatment summary.
• Guest restricted activity or was advised to rest?

Witnesses, Reporting, and Follow-up

• Were there witnesses?
• Witness summary
• May this incident be reportable to VSP?
• May this incident be reportable to port health authorities?
• Follow-up actions
• Follow-up notes