Sample Personal Location Form (PLF)
To be completed by all participants of the event
Name as shown in the passport or other ID:

Your permanent address (street/apartment/City/postal number/Country):

Your address during the event:

Your telephone number:

Your e-mail address:

Countries that you visited or stayed in last 14 days
Within the past 14 days, have you:

had close contact with anyone diagnosed as having Coronavirus disease COVID-19?     YES NO
provided direct care for COVID-19 patients?
visited or stayed in a closed environment with any patient having Coronavirus disease COVID-19?  YES NO
worked together in close proximity, or sharing the same classroom environment with COVID-19 Patient? YES NO 
traveled together with COVID-19 patient in any kind of conveyance?  YES NO
lived in the same household as a COVID-19 patient?       YES NO 

  • Facebook union nautique marseillaise
  • Chaîne Youtube de l'UNM