Support for Travellers Form - Print

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support-for-travellers

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Are there additional travellers in your group?
For each traveller, please list their last name, first name and date of birth
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Arrival ByMissing or incorrect value
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Do you have accommodation arranged for your self-isolation period?Missing or incorrect value
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If Yes, isolation type?Missing or incorrect value
Do you need accommodation assistance to self-isolate from anyone who is over 60 years old or who has heart disease, high blood pressure, asthma or other lung disease, diabetes, cancer, immune suppression or is taking prednisone medication?Missing or incorrect value
Are you able to make the necessary arrangements for your self-isolation period? (e.g. food, medication, child care, cleaning supplies, pet care).Missing or incorrect value
What form of transportation will you take to your self-isolation location?
Certify declarationMissing or incorrect value

Proceed to the provincial check point, if available at your location, where you may be asked to confirm how you will comply with the provincial order to self isolate

Your personal information as well as those of your household is collected by the Ministry of Health under the authority of sections 26(a), (c), (e) and s.27(1)(a)(iii) of the Freedom of Information and Protection of Privacy Act, the Public Health Act and the federal Quarantine Act, for the purposes of reducing the spread of COVID-19. Personal information may be shared with personnel providing support services and follow-up during self-isolation. Should you have any questions or concerns about the collection of your personal information please contact: 

Title: Ministry of Health, Chief Privacy Officer
Telephone: 236-478-1666

HLTH 8100

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