Traveler Health Declaration Form

Arriving passengers report their flight, destination, recently visited countries and any symptoms in the last 24 hours. Screening staff then log a temperature reading and decide whether the traveler is cleared.

Use this template

In the Claude connectors directory

Traveler instructions

Name

First Name

Last Name

Email

Date of birth

Phone number

Gender

Airport or terminal of origin

Arrival date

Airline

Flight number

Seat number

Destination address

Street Address

City

State / Province

ZIP / Postal Code

Countries visited in the past 14 days

For screening staff only

Current temperature

Does the traveler appear unwell?

Yes No Not sure

Clearance

Cleared Refer to secondary screening Not cleared

Screener's name

First Name

Last Name

Submission date

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