Passenger COVID Health Screen and Manifest Form

Staff and passenger safety is our #1 priority and we need your help! We ask that all passengers complete a health check prior to boarding our vessels. If you fail the Health Check you will be asked to travel on the outside deck of our vessel.

All passengers are required to wear a masks onboard vessels.

Vessel Name*

Other

If other, please write the name of the vessel

DATE:*

Date

Hour MinutesAM/PM Option

NAME:*

First NameLast Name

Email*

example@example.com

PHONE NUMBER:*

Please enter a valid phone number.

Result calculation

Results

1. Do you have a fever (38 C or higher) or a feeling of fever (chills)?*

YESNO

2. Do you have a cough?*

YESNO

3. Do you have difficulty breathing or chest pain?*

YESNO

4. Have you lost your sense of smell or taste without nasal congestion?*

YESNO

5. Have you had any other symptoms such as: major fatigue, headache, congestion/runny nose, nausea/vomiting/diarrhea?*

YESNO

6. Do you have any other symptoms that concern you? (muscle aches, sore throat, headache etc.) If yes, please specify:

8. In the past 14 days, have you been in contact with a suspected COVID-19 positive?*

YESNO

9. In the past 14 days, have you been in contact with a confirmed case of COVID-19 positive?*

YESNO

10. Have you been diagnosed with COVID-19 or do you think you've had it?*

YESNO

Body Temperature

Celsius

REMINDER! IT IS IMPORTANT TO:

Wash your hands frequently with soap
Respect social distancing measures of 2m as much as possible
Masks MUST be worn at all times while onboard the vessel and all FBMG property

Passenger Acknowledgement

Prior to departure, our captain had advised us of the following:

Location of the life jackets onboard.
The location of the First Aid Kit onboard
The location of the Fire Extinguisher onboard.
COVID-19 Precautions

I understand that when the vessel is underway that I must have three points of contact as the vessel may make sudden moves at any time.

I understand that if someone ends up falling overboard that I am to alert the captain immediately and maintain a visual of the person at all time and point towards them.

I am aware that I must advise the captain before storing any bags or cargo so that I’m not blocking an evacuation or fire exit.

I understand that if there is an emergency that I may be called upon to assist.

I am aware that the skipper onboard is the designated first aid attendant and that if I have any health concerns that I will let them know and that the info is confidential.

The skipper has the right to deny boarding if passengers are under the influence of drugs and alcohol, or who is acting in a threatening manner towards staff or other passengers, or who are not following public health mandates for COVID-19.

Any questions on the safety of myself or other passengers I will ask the captain.

Sign below to accept the acknowledgement

CONSENT & VALIDATION

I certify to the best of my knowledge that this information is accurate.

Signature*

Clear

Passenger COVID Health Screen and Manifest Form - BC Hydro

QUESTIONS

TEMPERATURE CHECK