Contactless Health-Screening Survey Template for Airlines

Use the contactless health-screening survey template for airlines to know if the passengers are healthy and safe to travel. Know if they are free from COVID-19 symptoms and take actions early to secure your staff's and co-passengers' health.

This free contactless health-screening questionnaire is a ready-to-use resource and can be customized as per your requirements. Let your staff and passengers know if they are fit enough before they board the flight. Collect their contact details and travel history to ensure timely action.

Contactless Health-Screening Survey Template for Airlines

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Contact Information (source country) First Name Last Name Contact Number Address Line 1 Address Line 2 City Zipcode Contact Information (destination country) Address Line 1 Address Line 2 City Zipcode Phone Select your date of stay from: Select your date of stay till: Have you, or anyone you have been in contact with, had a positive test or presumptive test for Covid-19 in the last 14 days? Yes No Have you had any signs or symptoms of a fever in the past 24 hours such as chills, sweats, or had a temperature that is elevated for you/100.0f or greater? This excludes any symptoms from any pre-existing condition. Yes No Are you experiencing any of the following symptoms? This excludes any symptoms from any pre-existing condition. Please check all that apply. Fever, chills or repeated shaking with chills Sore throat New cough (not related to chronic condition) Nasal congestion or runny nose (not related to seasonal allergies) Muscle aches New loss of taste or smell Shortness of breath or chest tightness (that is new/unusual to you) No symptoms Do you have valid health insurance in the country travelling to? Yes No Are you ready to wear a mask within the flight? Yes No Have you traveled to any other country besides your port of origin over the last 14 days?' Yes No Please select the country. Please select the number of days you have stayed in the country.