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  • Self-declaration form for coronavirus vaccination


Self-declaration form for coronavirus vaccination

Published Updated

Here is a self-declaration form that can be used for coronavirus vaccination. This is a voluntary tool for structuring the collection of necessary information in connection with coronavirus vaccination.

Egenerklæringsskema EN 08.04.2022.PNG

Self-declaration form before vaccination

This can be filled in by the person to be vaccinated, brought on the vaccination day where the vaccinator can use it as documentation until electronic registration is possible.
08.04.2022: The form has been updated. 
Information about the various diseases and conditions that were on the back page of the form can be found here: 

22.04.2022: All languages replaced. Russian and Ukrainian added.

08.04.2022: Replaced Norwegian and English. Updated questions and text on page 2 removed.

01.02.2022: All languages have been replaced.

25.01.2022: Updates: There are changes in the sections about having had COVID-19, severely impaired immune system, and breastfeeding and pregnancy. There is also a change in the 4th bullet point, where the sentence about adolescents is removed. The language versions will be replaced as they become available. 25.01.2022 - Bokmål and English replaced

14.09.2021: All language versions updated

10.09.2021: Updated nynorsk, bokmål, English, other languages will be updated when the translations are ready. Changes due to updates regarding vaccination of adolescents.

03.09.2021: Replaced the remaining languages as per changes 01.09

01.09.2021: Sentence removed - "waiting for test results." Norwegian versions and English version replaced, the other langauges will be replaced as they become available.

23.08.2021: Updated Nynorsk, Nordsamisk, Arabic, Lithuanian, Polish, Romanian, Tigringja, Urdu

19.08.2021: Changed advice about pregnancy and breastfeeding. Updated Bokmål and English.

11.06.2021: New version - removed text about betablockers, shortened text about bleeding tendency

25.05.2021: Added other language versions: Arabic, Lithuanian, Polish, Romanian, Somali, Tigrinja, Urdu

30.04.2021: Updated version - question and text about pregnancy and breastfeeding.

22.04.2021: Updated versions 

19.04.2021: Updated versions. Removed checklist.

07.04.2021: Updated versions 

25.03.2021: Updated with question about mast cell disease

12.05.2021: Updated list of beta-blockers

16.03.2021: Updated versions 



    Om printed publication

  • Year: Dec 2020, Feb 2021, Mar 2021, Apr 2021, July 2021, Aug 2021, Sept 2021, Jan 2022, Apr 2022
  • By: Norwegian Institute of Public Health