Vorlage Englisch

WHA58.3

ANNEX 9

THIS DOCUMENT IS PART OF THE AIRCRAFT GENERAL DECLARATION, PROMULGATED BY THE INTERNATIONAL CIVIL AVIATION ORGANIZATION1

HEALTH PART OF THE AIRCRAFT GENERAL DECLARATION

Declaration of Health

Persons on board with illnesses other than airsickness or the effects of accidents (including persons with symptoms or signs of illness such as rash, fever, chills, diarrhoea) as well as those cases of illness disembarked during the flight …………………………………............................................... …………………………………………………………………………………………………...............

Any other condition on board which may lead to the spread of disease

…………………………………………………………………………………………………...............

Details of each disinsecting or sanitary treatment (place, date, time, method) during the flight. If no disinsecting has been carried out during the flight, give details of most recent disinsecting

……………………………………………………………………………………................................... …………………………………………………………………………………………………...............

Signature, if required: …………………………………………………………………………...............

Crew member concerned

Eighth plenary meeting, 23 May 2005 A58/VR/8

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