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Run: Cruise Ship Port Health Authority Illness Notification Form

This cruise ship port health authority illness notification form captures vessel details, onboard illness counts, symptom patterns, care status, and response...

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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. (required)

Yes No N/A

Vessel and Voyage Details

Vessel name (required)

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 (required)

Expected arrival date (required)

Expected arrival time

Illness Summary

Number of ill passengers (required)

Number of ill crew (required)

Reported symptom categories (required)

Brief symptom description (required)

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? (required)

Number of cases under medical care

Are isolation or cohorting measures in place? (required)

Has medical escalation or shore-side support been requested? (required)

Ship Response Actions

Response actions taken (required)

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 (required)

Reporting contact role (required)

Reporting contact email (required)

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. (required)

Yes No N/A

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Email (required)

Your name (optional)

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