Cruise Staff Medical Clearance Form
Please complete this form to confirm your medical fitness for cruise duty. All information will be treated confidentially and used solely for fitness screening.
Full Name
*
First Name
Last Name
Position/Job Title
*
Email Address
*
example@example.com
Do you currently have, or have you recently experienced, any of the following symptoms? (Select all that apply)
*
Fever
Cough
Shortness of breath
Loss of taste or smell
None of the above
Have you been diagnosed with any chronic medical conditions? (e.g., diabetes, heart disease, asthma)
*
Yes
No
If yes, please specify your chronic medical conditions
Are you currently taking any medication?
*
Yes
No
If yes, please list your current medications
Have you been hospitalized or undergone surgery in the past 12 months?
*
Yes
No
Submit Medical Clearance
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