Dominica Health Questionnaire
Please complete the form below

• The fields marked with a red asterisk are mandatory.



Demographic Information


Permanent address (non-nationals) /Address in abroad (nationals)

Flight/Route Information



Add Country

Medical Information


Other Social/Behavioural Information


PCR/RD Test


Please only upload jpg, png or pdf, any other file types will cause your submission to fail.

Terms and Conditions


By completing and submitting this questionnaire, you are agreeing to comply with and be bound by the following terms and conditions -
All travelers are required –


All travelers are required –
1. to sanitize their hands at sanitization stations as directed;
2. to undergo a health assessment to include a temperature check;
3. to undertake a Rapid Diagnostic Test.
4. to wear mask at all times.

A. Upon clearance from the port, travelers from countries within the CARICOM Travel Bubble must adhere to the following:
1. Submit to scheduled and unscheduled checks by medical professionals
B. Upon clearance from the port, travelers from low risk countries must adhere to the following:
1. Travelers will be monitored for seven (7) days at their place of residence
2. All travelers must submit to scheduled and unscheduled checks by medical professionals.
C. Upon clearance from the port, travelers from medium risk countries must adhere to the following:
1. Traveler will be monitored for 14-days at their place of residence
2. Optional to 14- day monitoring, a PCR test can be done on day 5. If the result is negative, there will be no further monitoring at their place of residence.
3. All travelers must submit to scheduled and unscheduled checks by medical professionals.
D. Travelers from high risk countries must comply to the following:
1. Traveller will proceed to secondary screening area
2. A Rapid Diagnostic Test will be administered on arrival

i. If Rapid Test is positive, a PCR test will be administered immediately and traveller will await the results in a Government approved facility (at travellers expense).

ii. If Rapid Test is negative, traveller will be transported to mandatory quarantine at a Government operated quarantine facility or Government-certified private property for a minimum of 5 days.

3. All travelers must submit to scheduled and unscheduled checks by medical professionals.
4. A PCR test will be administrated to the traveller on Day 5 after arrival.

All costs incurred during the period of quarantine/treatment including PCR test must be paid prior to discharge.

Penalties will be applied for giving false information in the questionnaire and disregarding the quarantine process.

Staff

  • 8
    ...

    Bob Nilson

    Project Manager
  • ...

    Nick Larson

    Art Director
  • 3
    ...

    Deon Hubert

    CTO
  • ...

    Ella Wong

    CEO

Customers

  • 2
    ...

    Lara Kunis

    CEO, Loop Inc
    Last seen 03:10 AM
  • new
    ...

    Ernie Kyllonen

    Project Manager,
    SmartBizz PTL
  • ...

    Lisa Stone

    CTO, Keort Inc
    Last seen 13:10 PM
  • 7
    ...

    Deon Portalatin

    CFO, H&D LTD
  • ...

    Irina Savikova

    CEO, Tizda Motors Inc
  • 4
    ...

    Maria Gomez

    Manager, Infomatic Inc
    Last seen 03:10 AM
Bob Nilson 20:15 When could you send me the report ?
Ella Wong 20:15 Its almost done. I will be sending it shortly
Bob Nilson 20:15 Alright. Thanks! :)
Ella Wong 20:16 You are most welcome. Sorry for the delay.
Bob Nilson 20:17 No probs. Just take your time :)
Ella Wong 20:40 Alright. I just emailed it to you.
Bob Nilson 20:17 Great! Thanks. Will check it right away.
Ella Wong 20:40 Please let me know if you have any comment.
Bob Nilson 20:17 Sure. I will check and buzz you if anything needs to be corrected.

General

System

General Settings

  • Enable Notifications
  • Allow Tracking
  • Log Errors
  • Auto Sumbit Issues
  • Enable SMS Alerts

System Settings

  • Security Level
  • Failed Email Attempts
  • Secondary SMTP Port
  • Notify On System Error
  • Notify On SMTP Error