Fillable Appendix A Nunavut and Northwest Territories Common Travel (Government of Nunavut)

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Appendix A Nunavut and Northwest Territories Common Travel (Government of Nunavut)

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July 13, 2020 Page 10 of 11
Appendix “A”
Nunavut and Northwest Territories Common Travel Area
Nunavut and Churchill, Manitoba Common Travel Area
Traveller’s Declaration
Background
1. The Chief Public Health Officer of Nunavut, in partnership with the Chief Public Health
Officers of the Northwest Territories and Manitoba has established two Common Travel
Areas:
a. The Nunavut and Northwest Territories Common Travel Area; and
b. The Nunavut and Churchill, Manitoba Common Travel Area.
2. This allows unrestricted travel between Nunavut and the Northwest Territories or between
Nunavut and Churchill, Manitoba for anyone who has not travelled outside Nunavut or the
Northwest Territories in the fourteen (14) days prior to travel and who have completed any
mandatory self-isolation ordered by the Chief Public Health Officer of Nunavut, the
Northwest Territories, or Manitoba.
3. Travellers who do not leave a Common Travel Area do not have to isolate prior to their
return home.
4. If you leave a Common Travel Area at any time you will have to isolate at a designated
facility prior to returning home.
5. The Nunavut and Churchill, Manitoba Common Travel area includes overland travel through
unpopulated areas between the Nunavut-Manitoba boundary and Churchill.
6. All Travellers intending to travel to Nunavut must complete this declaration and submit it to
CPHOTravelrequests@gov.nu.ca
in order to receive a letter of authorization permitting
travel and present it to the air carrier upon check-in for verification.
7. A parent or guardian may complete the declaration on behalf of their minor children.
8. Making a false declaration is a breach of the Travel Restriction Order.
Declaration of Traveller
1. I, intend to travel to
(community) on (date).
2. I have been physically present within the boundaries of Nunavut, the Northwest Territories,
or Churchill, Manitoba for the past fourteen (14) days.
3. I will not leave the following Common Travel Area during my trip (check the appropriate
box):
a. Nunavut and Northwest Territories Common Travel Area ⎕
b. Nunavut and Churchill, Manitoba Common Travel Area ⎕
July 13, 2020 Page 11 of 11
4. I acknowledge that if I leave the Common Travel Area at any time during my trip, I will have
to isolate at a designated facility for at least fourteen (14) days before I can return to
Nunavut or the Northwest Territories, and will be responsible for arranging and paying to
travel to a designated facility.
5. I consent to the collection of the Contact Tracing Information set out below.
Contact Tracing Information
The following information is collected pursuant to section 17 (1) of the Public Health Act and will be
used to contact the Traveller in the event of an outbreak of novel coronavirus COVID-19, or where
the Chief Public Health Officer has reasonable grounds to believe that the Traveller may have been
exposed to novel coronavirus COVID-19. This information may be shared with the Chief Public
Health Officer of the Northwest Territories or the Chief Public Health Officer of Manitoba.
Traveller’s Permanent Address:
Traveller’s Address in Nunavut:
(The name and community of the Traveller’s tourist accommodation is acceptable)
Traveller’s Phone Number(s):
Traveller’s E-Mail Address (optional):
I make this declaration on (date) at (community).
Print Traveller’s Name Traveller’s Signature
Privacy Notice
The information on this form is personal information and is protected by the Access to Information
and Protection of Privacy Act and the Public Health Act. If you have questions about how the
Government of Nunavut collects, uses, and discloses personal information, contact the Office of the
Chief Public Health Officer or the Territorial ATIPP Office at atipp@gov.nu.ca
.
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Appendix A Nunavut and Northwest Territories Common Travel (Government of Nunavut)

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Completed 18 November 2020

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