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Public Health Passenger Locator Form International Flights

This document is a public health passenger locator form used by Bolivia for international flights. It collects contact information from passengers to allow health officials to follow up if a communicable disease exposure occurs on a flight. The form requests information such as name, flight details, addresses, phone numbers, and travel companions to facilitate contacting passengers as needed for public health purposes. Completing the form accurately and fully helps protect health.

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Hno Andru IS
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84 views1 page

Public Health Passenger Locator Form International Flights

This document is a public health passenger locator form used by Bolivia for international flights. It collects contact information from passengers to allow health officials to follow up if a communicable disease exposure occurs on a flight. The form requests information such as name, flight details, addresses, phone numbers, and travel companions to facilitate contacting passengers as needed for public health purposes. Completing the form accurately and fully helps protect health.

Uploaded by

Hno Andru IS
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ESTADO PLURINACIONAL DE BOLIVIA

PUBLIC HEALTH PASSENGER LOCATOR FORM


INTERNATIONAL FLIGHTS

To protect your health, public health officers need you to complete this form whenever they suspect a communicable disease onboard a flight. Your information will help public health officers to

contact you if you were exposed to a communicable disease. It is important to fill out this form completely and accurately. Your information is intended to be held in

accordance with applicable laws and used only for public health purposes. "Thank you for helping us to protect your health".

One form should be completed by an adult member of each family. Print in capital (UPPERCASE) letters. Leave blank boxes for spaces.

FLIGHT INFORMATION: 1.Airline name 2. Flight number 3. Seat number 4.Date of arrival (yyyy/mm/dd)

PERSONAL INFORMATION: 5. Last (Family) Name 6. First (Given) Name 7.Middle Initial 8. Your sex
M: F:

PHONE NUMBER(S) where you can be reached if needed. Include country code and city code.
9.Mobile 10. Business

11. Home 12. Other

13. Email address

PERMANENT ADDRESS: 14. Number and street (Separate number and street with blank box) 15. Apartment number

16. City 17. State/Province

18. Country 19. ZIP/Postal code

TEMPORARY ADDRESS: If you are a visitor, write only the first place where you will be staying.

20. Hotel name (if any) 21. . Number and street (Separate number and street with blank box) 22. Apartment number

23. City 24. State/Province

25. Country 26. ZIP/Postal code

EMERGENCY CONTACT INFORMATION of someone who can reach you during the next 30 days.

27. Last (Family) Name 28. First (Given) Name 29. City

30. Country 31. Email

32. Mobile phone 33. Other phone

34. TRAVEL COMPANIONS – FAMILY: Only include age if younger than 18 years
Last (Family) Name First (Given) Name Seat number Age <18
(1)

(2)

(3)

(4)

35. TRAVEL COMPANIONS - NON-FAMILY: Also include name of group (if any)
Last (Family) Name First (Given) Name Group (tour, team, business, other)
(1)

(2)

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