RallyTurkey | COVID-19 Form

NAME OF THE TEAM MANAGER / RESPONSIBLE PERSON (THIS PERSON WILL GET ACCESS TO THE TEST RESULTS OF THEIR TEAM / GROUP) *

MOBILE PHONE OF THE TEAM MANAGER / RESPONSIBLE PERSON *

EMAIL ADDRESS OF THE TEAM MANAGER / RESPONSIBLE PERSON *

CORPORATION/TEAM NAME *

NAME, SURNAME *

TURKISH ID CODE OR DATE OF BIRTH *

PERSONAL MOBILE PHONE INCLUDING COUNTRY CODE (FOR COMMUNICATING TEST RESULTS) *

PERSONAL E-MAIL *

COUNTRY OF ORIGIN *

ROLE IN THE TEAM *

Driver / Co-driver

Other

HAS THE PERSON EVER BEEN TESTED POSITIVE WITH COVID-19? *

Yes

No

PLANNED ARRIVAL DATE IN TURKEY *

MM

/

DD

/

YYYY

ARRIVAL TIME *

WAY OF TRAVEL TO TURKEY *

By plane via airport

By boat via port

By land

The person has stayed in Turkey and not left during the 14 day period before 6 September 2020

Other

TRAVEL INSURANCE OF THE PERSON *

The person has a travel insurance covering medical services.

The person pays for the medical costs by himself/herself.

END OF QUESTIONNAIRE *

YES

NO

I am returning to Germany or Switzerland etc. and will require a pre-departure test maximum 48 hours before departure

I am returning to Russia etc. and will require a pre-departure test maximum 72 hours before departure

END OF QUESTIONNAIRE [CONTINUE] *

[CONFIRM]

I hereby confirm that the person entered by me is healthy and is not infected with COVID-19. *

I hereby confirm that the person entered by me has no COVID-19 symptoms when entering Turkey.

I hereby confirm that the person entered by me agrees to take the COVID-19 test within 24 hours upon arrival to Turkey and grants his or her permission to the Organiser to obtain and process the test results for safety and medical reasons.

I hereby confirm the following:

[CONFIRM]

I hereby confirm that the person entered by me is healthy and is not infected with COVID-19. *

I hereby confirm that the person entered by me has no COVID-19 symptoms when entering Turkey.

I hereby confirm that the person entered by me agrees to take the COVID-19 test within 24 hours upon arrival to Turkey and grants his or her permission to the Organiser to obtain and process the test results for safety and medical reasons.

I hereby confirm the following:

END OF QUESTIONNAIRE [CONTINUE] *

YES

NO

Fever

Cough

Tiredness

Pain

Throat Pain

Dierhea

Headache

Shortness of Breath

Taste Sence Disorder.

Taste Sence Disorder

I hereby confirm that the person entered by me has given its consent that in case of a positive Covid-19 test its sensitive personal data (e.g. name, contact details, Covid-19 test results, whereabouts) will be shared directly by the accredited approved test provider with the FIA, the WRC Promoter, Rally Turkey / TOSFED and the responsible Team Manager, only for the purpose of our collaborative effort to ensure self-isolation and safeguard public health during the coronavirus pandemic. *

I CONFIRM THE STATEMENT ABOVE

Test Date *