Travel information report form in Krabi Province

1. In this survey, the officer will use your information for academic consideration.
2. For those who are in risk according to the principle of technical knowledge, the officer will contact back for more information.
3. In case that you or your relevant person start to have fever, cough, or sputum please contact to the hospital as soon as possible.
4. If you do not have a mobile phone that can be used for the registration. You can notify the officer at the checkpoint in order to fill your information in QT14 system.
Agreement and Consent for data transfer.
I agree with Krabi provincial public health office and the other office under the Ministry of Public
Health to collect and use my information for the benefit of screening, preventing and control
the spread of COVID-19 and other communicable diseases. By agreeing to only reveal an information to the agency assigned by the Krabi Provincial Health Office.

I certify that my information that I provided is real, accurate and up to date information.

Traveler information

Travel from - to
Place of residence in Krabi Province
Risk history
1. Within the past 2 weeks, I have been to high risk place or such a place that was crowded such as Boxing Stadium, Night Pub or Stadium.
2. Within the past 2 weeks, I have been participated in any events that was crowded
3. Within the past 14 days, have you had contact or been in the same place with anyone that you know had COVID-19 or COVID-like symptoms? Contact is being 6 feet (2 meters) or closer for more than 15 minutes with a person, or having direct contact with fluids from a person with COVID-19 (for example, being coughed or sneezed on).
4. Your health condition