Cruise Ship Port Health Authority Illness Notification Form

Pre-arrival illness notification form for cruise ships to report onboard illness counts, symptom patterns, medical care status, and response actions to port health authorities.

Submission Notice

• Submission purpose
• I confirm the information provided is accurate to the best of my knowledge and is shared for public health notification purposes.

Vessel and Voyage Details

• Vessel name
• IMO number
  Enter the vessel IMO number if available. Do not include other registry identifiers unless requested by the authority.
• Voyage number
• Last port of call
• Expected arrival date
• Expected arrival time

Illness Summary

• Number of ill passengers
• Number of ill crew
• Reported symptom categories
• Brief symptom description
  Provide a concise summary of the symptoms and onset pattern. Avoid unnecessary clinical detail.
• Approximate symptom onset date
  Use the best available estimate if exact timing is unknown.

Medical Care and Case Status

• Are any cases currently under medical care?
• Number of cases under medical care
• Are isolation or cohorting measures in place?
• Has medical escalation or shore-side support been requested?

Ship Response Actions

• Response actions taken
• Additional response details
  Include only operational details relevant to public health response.
• Additional support requested from port health authority
  Describe any specific support needed, such as inspection coordination, testing guidance, or arrival instructions.

Reporting Contact and Declaration

• Reporting contact name
• Reporting contact role
• Reporting contact email
• Reporting contact phone
  Provide a phone number only if the authority may need immediate follow-up.
• I confirm this notification is complete and accurate, and I understand it may be used for public health follow-up and audit trail purposes.