Agenda Item: 10a_Attach1
Meeting Date: June 8, 2021
Checklist for Port and Local Health Authorities: Cruise Ship Operator Agreements 
Checklist for Port and Local Health Authorities: Cruise
Ship Operator Agreements under CDC's Framework for
Conditional Sailing Order (CSO) 
Background 
This checklist is intended to assist U.S. port and local health authorities in their deliberations with cruise ship
operators seeking to enter into agreements with port and local health authorities with jurisdiction where a ship
intends to dock or make port during one or more simulated voyages and commence restricted passenger voyages
under CDC's Framework for Conditional Sailing Order (CSO).
As required under the CSO, a cruise ship operator's agreement with U.S. port authorities and local health authorities
must include the following elements: (1) a port component (including a vaccination component) between the cruise
ship operator and port authority to determine the number of cruise ships operating out of any single port in order to
not overburden the public health response resources of any single jurisdiction in the event of a COVID-19 outbreak;
(2) a medical care component between the cruise ship operator and health care entities, addressing evacuation and
medical transport to onshore hospitals for passengers and crew in need of medical care, in accordance with CDC
technical instructions and orders; and (3) a housing component between the cruise ship operator and one or more
shoreside facilities for isolation and quarantine of passengers or crew members with COVID-19 and close contacts,
identified from the day of embarkation through disembarkation for each voyage.
This checklist is not intended as, and does not constitute, a comprehensive statement regarding a cruise ship
operator's duties and obligations under the CSO. This checklist reflects CDC's reasoned judgement based on the best
available current science regarding the subject areas covered in this document. U.S. port, and local public health
authorities should carefully consider each item within this checklist in developing their own jurisdiction's health and
safety protocols. 
In deliberating with cruise ship operators, U.S. port and local health authorities consistent with their own jurisdiction's
legal authorities, needs, and local considerations may impose additional requirements that reflect a higher level of
public health protection than in this checklist and do not otherwise conflict with CDC's exercise of federal authority.
Additionally, U.S. port authorities and local health authorities should take into consideration CDC's Interim Public
Health Recommendations for Fully Vaccinated People. For purposes of these instructions, CDC considers cruise ships
to constitute a residential congregate setting. 
For the purpose of this checklist, and the Technical Instructions for a Cruise Ship Operator's Agreement with Port and
Local Health Authorities under CDC's Framework for Conditional Sailing Order only, the following definitions apply:
"local health authorities" refers to all health departments responsible for implementing state, territorial, and
local laws relating to public health (e.g., city, county, territorial, and/or state health departments) and
exercising jurisdiction over the U.S. port where the cruise ship operator intends to conduct one or more
simulated voyages and commence restricted passenger operations.
"U.S. port authorities" refers to officials responsible for exercising oversight and control over the U.S. port
where the cruise ship operator intends to conduct one or more simulated voyages and commence restricted
passenger operations.
Cruise Ship Operator and Ship Information 
Name of Cruise Ship Operator: 
Name of Cruise Ship(s):
Port of Embarkation/Debarkation: 
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Checklist for Port and Local Health Authorities: Cruise Ship Operator Agreements 

General Terms and Conditions 
Includes contact information for all parties to the agreement, including the cruise ship
operator, U.S. port authority where the cruise ship operator intends to conduct one or
more simulated voyages and commence restricted passenger operations, and all health
departments exercising jurisdiction over the port. The signatories to the agreement must
include the following: 
a)  The cruise ship operator's responsible officials, meaning the Chief Executive
Officer (or equivalent) of the operating cruise company and all parent companies,
1. 
the Chief Compliance Officer (or equivalent) of the operating cruise company and
all parent companies, and the highest-ranking Medical Officer of the operating
cruise company and all parent companies. 
b)  The highest-ranking officials for all relevant local public health authorities, except

that such officials may delegate at their own discretion. 
c)  The U.S. port authority's highest-ranking official. This individual will typically be

designated as the Port Director/Chief Executive Officer. 
Lists the cruise ship operator's ships covered by the terms of the agreement. Only those
2.         
cruise ships specifically listed by name in the agreement are covered by its terms. 
Includes total number of ships (including maximum number of travelers [passengers and
crew]) permitted to operate, make port, embark, or disembark. The parties to the
agreement should jointly consider the number of ships (including maximum number of
travelers [passengers and crew]) that can safely operate, make port, embark, or
disembark at any one time without exceeding the ability of local public health, port
3. 
authority, hospital, and other emergency response personnel to respond to an onboard
outbreak of COVID-19. 
a)  Includes a brief explanation of the factors relied upon by all parties in determining
these numbers, including the potential for COVID-19 variants, which could
undermine vaccine efficacy. 
Specifies the following: 
number of ships that will be permitted to make port, embark, and disembark, 
4.          
hours of the day and days of the week during which these activities will occur, and 
maximum number of travelers permitted during those hours and on those days. 
Includes a clause maintaining the right of the parties to the agreement to modify, amend,
or rescind the agreement. The parties should also maintain the right to temporarily 
5.              suspend or rescind an agreement if resources in the local community (e.g., local public
health, port authorities, hospital, or emergency response personnel) become insufficient
to adequately respond to an onboard outbreak of COVID-19 on a cruise ship. 
6.              Includes a plan to monitor and enforce compliance with the agreement. 
Includes requirements for reporting of cases identified during a voyage to the local health
authorities, including thresholds for reporting, timelines, reporting mechanisms, and
7.              points of contact. Such reporting requirements, if any, should be incorporated into the
agreement and may be in addition to, but not replace, CDC-mandated reporting by cruise
ship operators. 
Vaccination Components 

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Checklist for Port and Local Health Authorities: Cruise Ship Operator Agreements 
Includes a plan and timeline for vaccination of cruise ship crew prior to resuming passenger
operations. Due to the international representation of cruise travelers, cruise operators must use
1.               either FDA-authorized vaccines or a vaccine product that has received emergency use listing from
the World Health Organization (WHO). 
The vaccination component of the agreement must also include: 
a)   Presentation of proposals regarding how the cruise ship operator intends to incorporate
vaccination strategies to maximally protect passengers and crew from introduction,
amplification, and spread of COVID-19 in the maritime environment and land-based
communities. 
b)  Designation of a cruise ship operator vaccine coordinator to oversee implementation and

2.                           maintenance. 
c)   Processes for vaccination of crew currently onboard as well as newly embarking crew,
including reporting side effects to appropriate public health agency. 
d)  Education component for port personnel and travelers about the importance of getting
the COVID-19 vaccine. 
e)  Processes for vaccination of port personnel who are expected to interact with travelers. 
Port Components 
Specifies embarkation procedures that the cruise ship operator intends to use during
simulated voyages and restricted passenger voyages. These embarkation procedures
must be designed insofar as possible to minimize contact between travelers and port
1.          
personnel. CDC may request that the parties modify or amend the agreement to reflect
changes to embarkation procedures based on "lessons learned" from the cruise ship
operator's simulated voyage(s) as described in the after-action report for each voyage. 
Specifies procedures for day-of-embarkation screening for signs and symptoms of COVID-
2.               19, laboratory testing of travelers, including testing locations and management of 
individuals who test positive and their close contacts. 
Includes emergency response plans in the event of a "worst case" scenario of multiple
ships' experiencing simultaneous outbreaks of COVID-19. If the port authority intends to
allow more than one cruise ship operator to operate at its port facilities, then the port
3.          
authority and local public health authorities should jointly consider emergency response
plans involving a "worst case" scenario of multiple ships from multiple cruise ship
operators experiencing simultaneous outbreaks of COVID-19. 
Includes clear protocols for contacting emergency medical services while at port for
4.               exigent circumstances not covered by the hospital component of the agreement (e.g., a
medical emergency not related to COVID-19, such as a heart attack). 
Includes clear protocols that avoid medical evacuations at sea to the greatest extent
possible for both COVID-19 and non-COVID-19 related medical reasons. Protocols rely on
commercial resources (e.g., ship tender, chartered standby vessel, chartered airlift) for
5.              unavoidable medical evacuation at sea and are designed to minimize the burden to the
greatest extent possible on Federal, State, and Local government resources, including U.S.
Coast Guard resources. All medical evacuations at sea must be coordinated with the U.S.
Coast Guard. 
Specifies disembarkation procedures that will be implemented in the event of an
6.          
outbreak of COVID-19, and that the cruise ship operator intends to use during simulated

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Checklist for Port and Local Health Authorities: Cruise Ship Operator Agreements 
voyages and restricted passenger voyages. CDC may request that the parties modify or
amend the agreement to reflect changes to disembarkation procedures based on "lessons
learned" from the cruise ship operator's simulated voyage(s) as described in the afteraction
report for each voyage. 
Specifies procedures to: 
a)  Avoid congregating of embarking and disembarking travelers (passengers and/or

crew). 
7.                      b)  Ensure disembarking and embarking travelers (from the same ship but different
voyages) do not occupy the same enclosed or semi-enclosed areas (e.g.,

gangways, terminal waiting spaces, check-in areas) within the same 12-hour
period. 
c)  Ensure disembarking and embarking travelers from different ships do not occupy
the same enclosed or semi-enclosed areas (e.g., gangways, terminal waiting
spaces, check-in areas) within the same 12-hour period. 
Includes procedures for informing port personnel who are expected to interact with
8.          
travelers (passengers and/or crew) of the risks of COVID-19 and how to prevent exposure. 
Considers incorporating specific procedures for routine testing and symptom monitoring
of port personnel who are expected to interact with travelers (passengers and/or crew). 
Additionally, employers should encourage employees to get the COVID-19 vaccine when
eligible and the vaccine is available. This includes but is not limited to the following
personnel: 
a)  Port agents/greeters 
b)  Security personnel 
9.                   c)  Transportation staff 
d)  Baggage handlers 
e)  Check-in staff 
f)  Cleaners/janitorial staff 
g)  Longshoremen 
h)  Maritime pilots 
i)  Delivery drivers 
Includes routine and outbreak-level cleaning procedures for areas where travelers are
reasonably expected to gather or otherwise make use of, including terminals and
restrooms. In addition, includes routine and outbreak-level cleaning procedures for
transportation vehicles under a cruise lines' control (e.g., buses, shuttle vans). For more
information about cleaning and disinfection, please refer to CDC's Detailed Disinfecting
10.                 Guidance for Facilities and Cleaning and Disinfection for Non-emergency Transport
Vehicles. 
a)  It is recommended that commercial transportation companies/drivers be provided
with information on cleaning procedures (taxi, ride share services, parking lot
shuttle vans). For this industry, please refer to CDC's COVID-19 webpage for
Specific Industries. 
Medical Care Components 

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Checklist for Port and Local Health Authorities: Cruise Ship Operator Agreements 
Includes documentation of contractual arrangements to provide for the emergency
medical transportation of critically ill persons with suspected or confirmed COVID-19 from
1.          
the ship to a shoreside medical facility in such as manner as to minimize potential for
exposure. 
Includes documentation of contractual arrangements with a shoreside medical facility or
healthcare system or multiple shoreside medical facilities or healthcare systems with

redundant capacities to ensure that travelers receive appropriate clinical evaluation,
including testing, and medical care when needed. 
a)  This requirement is to reduce the need to divert patients to other medical facilities
or healthcare systems that do not have such a contractual arrangement with the
2. 
cruise ship operator. 
b)  If the cruise ship operator intends to rely on the services of a single medical facility
or healthcare system, it must document that it has made contractual
arrangements with a second medical facility or healthcare system if its primary
medical facility or healthcare system is unable to accept additional patients or
provide the necessary level of care. 
Includes documentation of contractual shoreside medical facilities or healthcare systems
that either singularly or collectively have enough medical capacity, in the judgement of
the local health authorities, to care for travelers if an unanticipated outbreak of COVID-19
3.               occurs on board the cruise ship operator's ships. The cruise ship operator's contractual
shoreside medical facilities or healthcare systems should have enough bed capacity for
both potential intensive care and non-intensive care needs, as well as enough capacity to
isolate patients with COVID-19. 
Considers the potential medical care needs of travelers including the capacity of local
public health, port authority, hospital, and other emergency response personnel to
respond to an onboard outbreak of COVID-19. 
4. 
a)  Includes a brief explanation of the factors relied upon by all parties in determining
the capacity of the cruise ship operator's contractual shoreside medical facilities
or healthcare systems. 
Evaluates the need for further contingency planning to provide medical care to travelers
in the event of limited hospital beds, medical personnel, or other factors potentially

limiting the capacity of the cruise ship operator's designated shoreside medical facilities
5. 
or healthcare systems. 
a)  Includes a brief explanation of the outcome of these deliberations. 
Housing Components 
Includes documentation of contractual arrangements (or corporate-owned shoreside
housing facilities) in sufficient quantities to meet the shoreside housing needs of travelers
(passengers and crew) for isolation and quarantine identified from the day of
embarkation through disembarkation for each voyage. In determining sufficient

quantities of shoreside housing for isolation and quarantine, the parties should consider
1. 
the potential for COVID-19 variants, which could undermine vaccine efficacy. The parties
may consider the following options for crew who are considered close contacts but have
tested negative for COVID-19: 
a)  All crew quarantine on board the ship provided that all crew can be housed in

single-occupancy cabins with private bathrooms. Essential crew may have a
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Checklist for Port and Local Health Authorities: Cruise Ship Operator Agreements 
working quarantine (i.e., continue working with appropriate public health
measures such as social distancing and face masks). 
b)  Essential crew stay on board the ship for a working quarantine (i.e., continue
working with appropriate public health measures such as social distancing and
face masks) while nonessential crew quarantine shoreside. 
c)  All crew quarantine shoreside and essential crew are replaced with a contingent of

alternate personnel. 
Considers where the ship will be physically located during the isolation and quarantine
period (i.e., at the pier or at anchor). In addition, considers the potential housing needs of
travelers including the capacity of local public health, port authorities, hospital, and other
emergency response personnel to oversee and monitor the housing needs of travelers
2. 
under isolation and quarantine. 
a)  Includes a brief explanation of the factors relied upon by all parties in determining
the sufficiency of the cruise ship operator's contractual or corporate-owned
shoreside housing facilities. 
Includes documentation of contractual arrangements (or has corporate-owned shoreside
housing facilities) in sufficient quantities as determined by the local health authorities to
3.          
meet the housing needs of travelers until they meet CDC's criteria to discontinue isolation 
or for the CDC-recommended quarantine period. 
Includes documentation of arrangements (or has corporate-owned vehicles) in sufficient
quantities to meet the transportation needs of all travelers from the ship to the shoreside
4.               housing facilities and from the shoreside housing facility to the contractual medical
facilities or healthcare systems if needed with precautions in place to avoid exposure of
vehicle operators. 
Shoreside housing meets CDC guidelines for isolation or quarantine including separate
bedrooms, bathrooms, and no shared living spaces for individuals who are not part of the
5.          
same household, and the ability to separate infected persons within households from
those not known to be infected. 
Shoreside housing provides separate ventilation systems for all travelers who are not part
6.          
of the same household. 
Considers the following needs of travelers (passengers and crew) under quarantine and
isolation and includes a brief explanation of the outcome of these deliberations in the
agreement: 
a)  Availability and frequency of testing including the logistics of specimen collection

and transportation of specimens to laboratories for testing. 
b)  Availability of mental health services, pharmacy delivery, and other essential

services. 
c)  Availability of security, including legal considerations, to prevent travelers from
7. 
violating the terms of any mandatory isolation or quarantine, and a mechanism to

notify public health authorities immediately in the event that a traveler attempts
to violate such terms. 
d)  A check-in process, including delivery of luggage, designed insofar as possible to

minimize contact between exposed travelers and unexposed persons. 
e)  Procedures to ensure the daily monitoring of travelers in quarantine, including
points of contact for travelers to notify if symptoms develop in between symptom
checks. 
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Checklist for Port and Local Health Authorities: Cruise Ship Operator Agreements 
f)   Procedures to minimize contact between travelers in quarantine and/or isolation

and support staff, while still ensuring the delivery of essential services: 
i.  Food delivery 
ii.  Laundry services 
iii.  Cleaning and linen change 
iv.  Garbage pick up 
v.  Post-quarantine cleaning and disinfection procedures 
g)  Post-isolation and post-quarantine procedures to allow travelers to safely return 

to their home communities. 
Signatures & Execution 
The agreement is signed and executed, and the cruise ship operator provides a copy
(including all attachments, exhibits, and annexes) to CDC, prior to CDC approving a cruise
1.          
ship operator's request to embark non-essential crew. The agreement must be emailed to
CDC at eocevent349@cdc.gov. 













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