UN
United Nations Peacekeeping
PROCEDURE
for completion/submission of
HEALTH SELF-ASSESSMENT FORMS
required for travel on UNMIL assets (air and road)
Background
1. In light of the outbreak of Ebola in Liberia and other countries in West Africa, UNMIL personnel traveling out of Liberian counties in which the presence of Ebola is suspected or confirmed are required to undergo medical screenings just prior to travel, whether by air or road.
2. Previously, this screening was only done for UNMIL personnel. However, given the spread of Ebola, UNMIL Leadership has directed that further precautionary measures be employed for travel on UNMIL assets by non-UN persons. Accordingly, a simplified “health self-assessment” form has been developed for the use of non-UN persons qualifying for travel on UNMIL assets (air, road), who wish to travel out of counties reporting suspected/confirmed Ebola cases.
3. This document provides information on where to obtain this self-assessment form, how to fill it out and the conditions under which it is to be provided.
What is the implementation date of this procedure and how long will it remain in effect?
4. This procedure is effective as of Monday, 14 July 2014. It remains in effect until further notice.
To whom does the self-assessment apply?
5. The self-assessment applies to and must be completed by all persons who are not UNMIL staff, who qualify for and desire to make use of UNMIL assets for travel out of Liberian counties where the presence of Ebola is suspected or confirmed.
6. Counties where Ebola is suspect/confirmed are identified through UNMIL Administrative Instructions that are also made available to the UN Country Team in Liberia.
7. The self-assessment is only required if traveling *from* one of the counties identified above. It is not needed for travel into these counties, or out of other counties in Liberia.
8. As of the 14 July 2014 date of implementation, a completed self-assessment must be presented by the traveler at the point of embarkation (if by air) or pickup (if by road vehicle). Persons will not be allowed to board without presenting a signed, completed self-assessment.
I qualify for travel on UNMIL assets – where can I obtain a copy of the self-assessment?
9. The self-assessment is available on UNMIL’s website: http://unmil.unmissions.org/ , as is a copy of this instruction.
How to I fill out the health self-assessment?
10. As this form is a self-assessment, its utility depends on the truthfulness with which you complete it. Please ensure that you provide all information requested, answer all the questions honestly and sign/date the self-assessment at the end.
11. Two factors affect the timing of the health self-assessment: it is only meaningful if completed a few days before departure; and in the case of air travel, UNMIL Air Operations requires time to finalize and close the passenger manifest. Accordingly, carry out your self-assessment no earlier than three (3) days and no later than one (1) day before travel.
Explanation of Fields on the Health Screening Self-assessment Form
|
Field/Section on Form |
Description / Comments |
|
Date and time of this assessment |
Fill in the date and time you conduct your self-assessment. Complete the self-assessment no more than 3 days before you intend to travel, as this constitutes the minimum “window” during which illness may develop. |
|
A) Non-UN Personnel Details |
Self-explanatory. Provide all information requested. |
|
B) Travel History |
Check “yes”, “no” or “unknown” in response to the question. Provide the additional information requested if you did not check “no”. |
|
C) Current Health Status |
Check the box that applies to you. |
|
D) Signs and Symptoms |
If you checked “I am currently unwell and have signs and symptoms”, then provide all the information requested under Part D). Do not leave any fields blank. |
|
E) Exposure History |
Answer every question in this part truthfully. |
|
Signature |
Don’t forget to sign and date your health self assessment! |
I’ve completed and signed my self-assessment, what now?
12. Present your document at the point of embarkation, where it will be collected and controlled as follows:
Procedure
12.1 If traveling by air, present your self-assessment, along with your MOP, to the MovCon Check-in Clerk. If traveling by road, present your self-assessment, along with your waiver, to the Driver. The Clerk or Driver will:
12.1.1 collect the form and date-stamp it;
12.1.2 review the form for completeness and content;
12.1.3 observe your physical state of health, in line with guidelines issued by UNMIL which in turn are derived from IATA guidelines used by airline “check-in” personnel.
12.2 If the Clerk or Driver has any concerns about your self-assessment and/or your apparent physical state of health, s/he will call for direction and carry out the direction given.
|
The Clerk or Driver has the right to stop you from boarding the flight or vehicle. This decision is final and may not be appealed.
If you are denied boarding, please comply with the instructions given by UNMIL personnel. |
13. Note that if you have several “legs” to your journey, you will only need to provide the self-assessment at the start of the first “leg”. You will not need to provide a form at each boarding location while in transit.
14. Any questions regarding this procedure should be referred to the Medical Screening Office at PAP Headquarters Annex, ext. 5851, mobile 0770 31 9163.