We enclose the new self-declaration form of the Italian Ministry of the Interior to bring if you have to leave home for strictly necessary reasons.

With the Decree of the Presidency of the Council issued on March 9, 2020 and entered into force from midnight on March 10, after the signature of the Prime Minister Giuseppe Conte, new preventive measures to prevent the spread of Coronavirus in Italy. These include limited travel throughout Italy and the form to bring if you leave home.

The Decree published in the Official Gazette contains further provisions implementing Decree Law no. 6 of 23 February 2020, containing urgent measures for the containment and management of the epidemiological emergency by COVID-19, applicable throughout Italy from 10 March 2020 until 3 April 2020.

UPDATE 11 March 2020: The President of the Council Giuseppe Conte signed the new Dpcm containing further measures on the containment and management of the epidemiological emergency from COVID-19 on the whole national territory. Link to the text of the decree

UPDATE 22 March 2020: The President of the Council Giuseppe Conte has signed a new Dpcm that introduces further measures on the containment and management of the epidemiological emergency from COVID-19, applicable throughout the entire national territory. Here the text of the decree

UPDATE 25 March 2020: The Minister of Economic Development Stefano Patuanelli has signed a new Dpcm which includes some changes to the Dpcm of 22 March.Link to the text of the decree

Decree #IoRestoAcasa

Movements throughout the national territory are forbidden unless proven:

work reasons
severe family needs
health reasons (Note: if you are positive or think you have the virus you should not go outside)

If you are stopped by the competent authorities it is mandatory to self-declare the reason why you are out (you will be asked to fill out a form, or you can print it and fill it out before leaving home).

What happens if you don’t respect the restrictions:
The penalty is imprisonment for up to 3 months or a fine of up to €206. Imprisonment from 1 to 12 years if you leave being quarantined or virus positive.

The new version is harmonised with Decree Law No. 19 of 25 March 2020. The declarant is required to specify not only the residence, but also the domicile. Dpcm of March 25th has been added among the measures of which he declares to be aware. In the new form it is necessary to indicate both where the movement started, and the destination of arrival, and the Region of origin and the region of arrival in case of movement from Region to Region.

Online Compilable PDF: nuovo_modello_autodichiarazione_26.03.2020_editabile





Il sottoscritto ________________________________________________________ , nato il ____ . ____ . _____
a ____________________________________ (______), residente in _______________________________________ (______), via ________________________________________ e domiciliato in _______________________________
(______), via ________________________________________, identificato a mezzo __________________________ nr. _____________________________________, rilasciato da _____________________________________________
in data ____ . ____ . _____ , utenza telefonica ________________________ , consapevole delle conseguenze penali
previste in caso di dichiarazioni mendaci a pubblico ufficiale (art. 495 c.p.)
➢ di non essere sottoposto alla misura della quarantena ovvero di non essere risultato positivo al COVID-19(fatti salvi gli spostamenti disposti dalle Autorità sanitarie);
➢ che lo spostamento è iniziato da ________________________________________________________________
(indicare l’indirizzo da cui è iniziato) con destinazione _______________________________________________
➢ di essere a conoscenza delle misure di contenimento del contagio vigenti alla data odierna ed adottate ai sensi
degli artt. 1 e 2 del decreto legge 25 marzo 2020, n.19, concernenti le limitazioni alle possibilità di spostamento
delle persone fisiche all’interno di tutto il territorio nazionale;
➢ di essere a conoscenza delle ulteriori limitazioni disposte con provvedimenti del
Presidente delle Regione ______________________________ (indicare la Regione di partenza) e del
Presidente della Regione ______________________________ (indicare la Regione di arrivo) e che lo spostamento rientra in uno dei casi consentiti dai medesimi provvedimenti __________________________________________ _________________________________________________ (indicare quale);
➢ di essere a conoscenza delle sanzioni previste dall’art. 4 del decreto legge 25 marzo 2020, n. 19;
➢ che lo spostamento è determinato da:
o – comprovate esigenze lavorative;
– assoluta urgenza (“per trasferimenti in comune diverso”, come previsto dall’art. 1, comma
1, lettera b) del Decreto del Presidente del Consiglio dei Ministri 22 marzo 2020);
– situazione di necessità (per spostamenti all’interno dello stesso comune o che rivestono carattere di quotidianità o che, comunque, siano effettuati abitualmente in ragione della brevità delle distanze da percorrere);
– motivi di salute.
A questo riguardo, dichiarache
(lavoro presso …, devo effettuare una visita medica, urgente assistenza a congiunti o a persone con disabilità, o esecuzioni di interventi assistenziali in favore di persone in grave stato di necessità, obblighi di affidamento di
minori, denunce di reati, rientro dall’estero, altri motivi particolari, etc….).
Data, ora e luogo del controllo
Firma del dichiarante L’Operatore di Polizia

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