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Travel questionnaire St. Eustatius Public Health

Form | 02-07-2020

A form for screening before traveling to St. Eustatius

Travel Questionnaire St. Eustatius Public Health

Nameverplicht *

Date of birthverplicht *

Port of embarkationverplicht *

Date of arrivalverplicht *

What is your address in St. Eustatiusverplicht *

What is your home addressverplicht *

E-mailverplicht *

How long are you planning to stayverplicht *

Business or pleasureverplicht *

Where have you travelled in the last 14 daysverplicht *

On which telephone number can we contact you. Local, international and familyverplicht *

Have you been in contact with any person(s) who recently travelled to or from listed countries in the last 14 days

United States of America Central or South America Europe Asia Canada Caribbean Region

verplicht *

The above questions have been answered truthfully. Failure to do so will result in sanctions.

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Information about the processing of your personal data

We use your data in order to respond to your question. Your data will not be shared with third parties.

Why is this data required?

We use your data – with your permission – because we need it to respond to your question.

How does your data get processed?

We use your data in order to respond to your question. Your question will be answered by our own staff. Your data will not be shared with third parties.

How long do we keep your data?

We will retain your data until we have answered your question. After that, your data will be deleted.

What are your rights?

You can find more information about your rights on page 'Privacy' (link opens in new tab).

Statement of agreementverplicht *

I have read and understood how my personal data will be processed.