Checklist for the traveller
&
QuestionnaireChecklist for the traveller
&
QuestionnaireRisks related to the area (urban or rural)
Type of accommodation (hotel, camping)
Length of stay
Altitude
Security problems (e.g. conflict)
Availability of medical facilities
Traffic (obtain a card showing blood group before departure)
Animals (beware of snakes and rabid dogs)
Allergies (use a medical alert bracelet)
Sun (pack sunglasses and sunscreen)
medical—obtain prescriptions for medication according to length of stay, and obtain advice from your physician on assembling a suitable medical kit
dental
ophthalmological—pack spare spectacles
other according to specific conditions (e.g. pregnancy, diabetes)
Subscribe to a medical insurance with appropriate cover abroad, i.e. accident, sickness, medical repatriation.
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Surname:
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First name: |
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Date of birth:
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Country of origin: |
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Purpose of travel:
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q Private q Professional |
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Special activities:
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q Accommodation:
e.g. camping, bivouac q Sports: e.g. diving, hunting, high-altitude trekking |
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| Date of departure and length of stay : |
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Places to be visited |
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Country
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Town
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Rural area
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Dates
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Yes No
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From to
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Yes No
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From to
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Yes No
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From to
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Yes No
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From to
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Yes No
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From to
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Medical history:
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| Vaccination record: |
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| Current state of health: |
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| Chronic illnesses: |
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| Recent or current medical treatment: |
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| History of jaundice or hepatitis: |
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| Allergies (e.g. eggs, antibiotics, sulfonamides): |
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| For women: |
q Current
pregnancy q Pregnancy likely within 3 months q Currently breastfeeding |
| History of anxiety or depression: |
q If
yes, treatment prescribed (specify) |
| Neurological disorders (e.g. epilepsy, multiple
sclerosis, etc.): |
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| Cardiovascular disorders (e.g. thrombosis, use of
pacemaker): |
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Source: www.who.int/ith/chapter01_04.html#checklist