P.O. Box 1000, Stn. 1000
Iqaluit, Nunavut X0A 0H0
C.P. Box 1000, Succursale 1000
Iqaluit, Nunavut X0A 0H0
Page 1 of 2
Request for travel exemption due to critical employment or compassionate need
When complete, please email your application to CPHOTravelRequests@gov.nu.ca with subject line ‘EXEMPTION REQUESTand
your anticipated travel date.
Date of Submission (DD-MM-YYYY)
First name Date of Birth (DD-MM-YYYY)
Employment information
Category* and reason for exemption (indicate the category of exemption you are requesting, and the reason it is critical)
Location of Work (in Nunavut)
Travel information
Travel date into Nunavut (DD-MM-YYYY)
Departure Point (flying from)
Ottawa Yellowknife Other (please specify)
Please note: the date
must correspond with
the approved critical
traveller days.
Winnipeg Edmonton
Travel History
Please state each travel location you visited in the last three weeks, and the dates you were in each location. If you travelled
internationally, please include your destination as well as any layovers that occurred during your travel:
First name
Government of Nunavut (GN) critical employment
Personal information
Last name
Non-GN critical employment
Non-GN critical trades employment
Compassionate exemption
Other (please specify)
*Descriptions of each category may be found on page 2.
Yes No
Health information
Do you have any known exposure to COVID19?
Are you symptomatic (fever, short of breath, cough)? Yes No
Agreement to self-isolation measures
Do you agree to the following self-isolation measures outside of working hours?
Yes No Initials:
Yes No Initials:
Yes No Initials:
1. Not visiting any local/retail stores:
2. Avoiding all gatherings/events:
3. Remaining isolated in room/house/hotel:
4. Maintaining social distancing (two meters): Yes No Initials:
P.O. Box 1000, Stn. 1000
Iqaluit, Nunavut X0A 0H0
C.P. Box 1000, Succursale 1000
Iqaluit, Nunavut X0A 0H0
Page 2 of 2
! Monitor closely for symptoms and immediately call the health centre if you develop symptoms.
Instructions for completing this form
To ensure that requests can be processed in a timely fashion, please ensure that all parts of this form are completed as
instructed. Incomplete forms may result in a delay in processing. Important: this form must be submitted within 7 days of
your travel to Nunavut. Please allow up to 2 business days for processing. Note that you have to receive a signed CPHO
travel authorization letter to board your flight. This letter is valid for 7 days after receipt.
Once approved, you will receive a travel agreement for contact tracing and enforcement purposes that must be signed.
Please read carefully. By signing this application, I declare the following: the information in this application and in any attachment is
true and accurate; I understand that if I choose to complete and submit this application electronically it will be equivalent to an
electronic signature, and will be treated in the same manner as if I had signed and submitted it through other means.
Providing misleading or false information in response to these questions or to the office of the Chief Public Health Officer constitutes
a breach of the Travel Restriction Order and can be punishable by a $575 fine.
Printed employee name:
Employee signature:
Categories of exemptions
The following definitions are meant as a general guideline, and must be accompanied by a rationale as to why the request for
exemption is critical. No position is deemed critical by nature of its job title alone.
Government of Nunavut exempted workers: a Government of Nunavut-employed worker who is required urgently in the territory because his or
her work is essential.
Non-GN Essential Trades: A Red Seal or Red Seal-Equivalent tradesperson who is required to perform essential work in the territory. "Red Seal-
Equivalent" means a worker who is on Red Seal Apprenticeship Track and who been prevented from taking the Red Seal exam due to COVID-19.
Non-GN Exempted Workers: A worker, employed by an employer other than the Government of Nunavut, who is required urgently in the territory
because his or her work and/or skills are considered essential and unfillable by another worker in the territory.
Physicians: Medical doctors who are required urgently in the territory.
Compassionate: Individuals who require urgent entry to the territory in order to attend to a sick immediate family member; to visit with a dying
immediate family member; or attend the funeral of an immediate family member.
click to sign
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