General Information
Terms and Conditions
Traveler Information
COVID-19 Traveler Screening Tool
Certification

U.S. VIRGIN ISLANDS
TRAVEL SCREENING PORTAL

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TRAVELER INFORMATION

Last Name:

First Name:

Middle Name:

Date of Birth:

Gender:

M F Other

Other:

Non-Binary Third Gender Prefer To Self-Describe

Cell Phone/Preferred Number:

Email:

Confirm Email:

Street:

City:

State:

Country:

Zip or Postal Code:

Country of Birth:

Nationality:

Where will you be staying?

Hotel/Resort Airbnb etc. Private Res Other

Name of the hotel or resort:

Are you traveling alone?

Yes No

(Please list travel companions)

Age:

4 or younger 5 or older

Name:

Relationship:

Gender:

M F Other

Other:

Non-Binary Third Gender Prefer To Self-Describe

Age:

4 or younger 5 or older

Name:

Relationship:

Gender:

M F Other

Other:

Non-Binary Third Gender Prefer To Self-Describe

Age:

4 or younger 5 or older

Name:

Relationship:

Gender:

M F Other

Other:

Non-Binary Third Gender Prefer To Self-Describe

Age:

4 or younger 5 or older

Name:

Relationship:

Gender:

M F Other

Other:

Non-Binary Third Gender Prefer To Self-Describe

Age:

4 or younger 5 or older

Name:

Relationship:

Gender:

M F Other

Other:

Non-Binary Third Gender Prefer To Self-Describe

Emergency contact

(This should not be someone in your travel party.)

Name:

Phone:

Email:

What is your method of travel?

Airline Marine

Airline:

Flight Number:

Seat Number:

Are you planning to sail/board a vessel within the next 10 days of your arrival?

Yes No

Travel dates

Name of vessel

Stops at any other ports/destinations

Yes No

Where?

Name of Vessel:

Vessel Number:

Passenger Number:

COVID-19 TRAVELER SCREENING TOOL

Have you had any of the following symptoms in the past 14 days?

1. Fever (100.4 °F or higher):

YES NO

2. Fatigue:

YES NO

3. Body aches:

YES NO

4. Persistent cough:

YES NO

5. Difficulty breathing:

YES NO

6. Loss of taste or smell:

YES NO

7. Any other symptoms:

YES NO

Please indicate:

8. Do you live in a household or have you had contact with a person sick with COVID-19?

YES NO

9. Have you been in contact with a person or persons who tested positive for COVID-19?

YES NO

Recent Travel Information

List the state or country of embarkation prior to arrival into the Territory

State/Country:

Airport:

State/Country:

Airport:

State/Country:

Airport:

State/Country:

Airport:

State/Country:

Airport:

Date of USVI arrival:

Signature:

By typing my name, I am providing an electronic signature.

Date:

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I understand that by not submitting a test result, I acknowledge that I will be subject to additional screening by my transportation carrier and by representatives of the U.S. Virgin Islands Department of Health upon arrival. I also acknowledge that I will be responsible for obtaining the required test result, including all associated costs, and will be subject to a mandatory self-quarantine until the required test result is provided. Travelers arriving without an acceptable test result may be subject to a fine imposed by the Government of the Virgin Islands. Additionally, I acknowledge that airlines may refuse boarding for any traveler that has not successfully completed the Travel Screening Portal, including an acceptable test result.

REMINDER: YOU MUST COMPLETE ALL ENTRIES IN ORDER TO SUCCESSFULLY COMPLETE THIS PROCESS

Traveler Information

First Name

Testing name

Last Name

Middle Name

Date of Birth

Gender

Cell Phone

Street

City

State

Country

Zip/Postal Code

Country of Birth

Nationality

Where will you be staying?

Name of the hotel or resort:

Emergency Contact Information

Name

Phone

Companion(s) Information

Name

Relationship

Gender

Age

Name

Relationship

Gender

Age

Name

Relationship

Gender

Age

Name

Relationship

Gender

Age

Name

Relationship

Gender

Age

Method of Travel

Airline Name

Flight Number

Seat Number

Are you planning to sail/board a vessel within the next 10 days?

Travel dates?

Name of vessel?

Stops at any other ports/destinations?

Where?

Name of Vessel

Vessel No.

Passenger No.

Symptoms Information

Fever

Fatigue

Body Aches

Persistent Cough

Difficulty Breathing

Loss of Taste or Smell

Any Other Symptoms

Symptom Specification

Living with COVID Infected Person

In Contact with COVID Positive Person

Recent Travel Information

Country

Airport

Country

Airport

Country

Airport

Country

Airport

Country

Airport

USVI Arrival Date

U.S. VIRGIN ISLANDSTRAVEL SCREENING PORTAL

TRAVELER INFORMATION

Emergency contact

COVID-19 TRAVELER SCREENING TOOL

Have you had any of the following symptoms in the past 14 days?

Recent Travel Information

Traveler Information

Emergency Contact Information

Companion(s) Information

Method of Travel

Symptoms Information

Recent Travel Information

U.S. VIRGIN ISLANDS
TRAVEL SCREENING PORTAL