Fillable Suggested Quarantine Plan

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Suggested Quarantine Plan

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1
Suggested Quarantine Plan
I am aware of all current federal and provincial (Québec) obligations related to my arrival in Canada
during the
COVID-19 pandemic, and, if there are discrepancies between them, I will follow the most
cautionary and stringent requirements.
Here are the contact details you can reach me:
- Email:
- Phone:
Section A: Complete this section ONLY IF you are not fully vaccinated according to the requirements issued by
the Canadian government (https://travel.gc.ca/travel-covid/travel-restrictions/covid-vaccinated-travellers-
entering-canada?_ga=2.35803680.1255815314.1624454550-
1422400670.1617990692&_gac=1.153685706.1623675447.CjwKCAjw_JuGBhBkEiwA1xmbReC_a_zfjNZp2n5dLA
9M-p8Y8QEz62a-iqSZi0k2sC4wzdDINOxv3BoC4CkQAvD_BwE)
Upon my arrival in Canada, I agree to observe a quarantine period of 14 days under the following conditions:
First place of quarantine for the first three days in a government of Canada-authorized hotel:
✓ I have booked a three-day stay in a government-authorized hotel in the Canadian city I will first arrive in. [When
you travel to Canada, please have with you a prepaid booking confirmation.] The hotel will be:
o Name:
o Address:
✓ I will go directly to the hotel using the hotel’s transportation [Specify how you will be getting there: shuttle,
taxi, etc.]:
Second place of quarantine after the three days in an authorized hotel:
✓
After I receive a negative test result from the COVID-19 test conducted upon my arrival in Canada, my
place of quarantine will be [Please also have with you proof of the place of quarantine, such as the
hotel booking confirmation, a message from a friend or family member confirming that you will be
staying with them, your rental lease, etc.]:
o Address:
o Name of hotel, if applicable:
✓
When I leave the government-authorized hotel, I will go directly to my place of quarantine using this
means of transportation [Please also have with you proof of this, such as the telephone number of a
taxi company, a message from someone confirming that they will be picking you up if they live where
you will be quarantining, proof of transportation provided by your hotel, a plane ticket for a domestic
flight, etc.]:
2
Section A
✓
I have (or My place of quarantine has) the necessities of life [Give more details, such as
soap,
towels, sheets, toilet paper, thermometer, mask, etc.]:
✓
I will arrange food supplies without leaving my place of quarantine as follows [Give details about
hotel food service options,
grocery stores, and/or restaurants near your place of quarantine with
delivery services
(business names and addresses), etc.]:
✓
I will arrange getting over-the-counter medication without leaving my place of quarantine as follows
[Give details about the medication you have with you and the pharmacy (name and address) that
can deliver more if needed]:
✓
I have the following prescription drugs with me and enough for one month [If this applies to you,
give details about the prescription drugs you have with you]:
✓
I will have access to the financial resources I need for my quarantine as follows [Provide as much
proof as possible that you have immediate access to enough funds to cover for the cost related to
the quarantine period: bank account summary, credit card that has a sufficient limit and that works
in Canada, etc.]:
3
Section B: Complete this section ONLY IF you are fully vaccinated according to the requirements issued by the Canadian
government (https://travel.gc.ca/travel-covid/travel-restrictions/covid-vaccinated-travellers-entering-
canada?_ga=2.35803680.1255815314.1624454550-
1422400670.1617990692&_gac=1.153685706.1623675447.CjwKCAjw_JuGBhBkEiwA1xmbReC_a_zfjNZp2n5dLA9M-
p8Y8QEz62a-iqSZi0k2sC4wzdDINOxv3BoC4CkQAvD_BwE).
✓ After I test positive for COVID-19 upon arrival in Canada or as a result of a border agent's
requirement, my quarantine location would be:
✓ The following people also normally reside where I will be quarantining or they are travelling with me.
1
They are not vulnerable individuals,
2
they do not provide care for vulnerable individuals, and they are
not health care workers. In addition, I will have my own bedroom that is separate from those used by
people who have not travelled with me. [If other people will be in the same place, give the names,
ages, and health of those people.]:
✓
When I leave the airport, I will go directly to my place of quarantine using this means of
transportation
3
[Please also have with you proof of this, such as the telephone number of a taxi
company, a message from someone confirming that they will be picking you up if they live where you
will be quarantining, proof of transportation provided by your hotel, a plane ticket for a domestic
flight, etc.]:
✓
I have (or My place of quarantine has) the necessities of life [Give more details, such as
soap,
towels, sheets, toilet paper, thermometer, mask, etc.]:
1
No other scenarios are allowed.
2
They do not have any underlying medical conditions that would make them susceptible to COVID-19 complications. They do not have a
weak immune system due to any health problems or medical treatment. Also, they are not 65 years of age or older.
3
Use private transportation if possible, such as the shuttle service some hotels offer, a taxi or a private car. If it's not possible, you can
board a domestic flight or take intercity transportation (bus or train) to get from one quarantine location to another. However, you must
use private transportation, such as a taxi, to get to and from the airports or stations.
4
Section B
✓
I will arrange food supplies without leaving my place of quarantine as follows [Give details about
hotel food service options,
grocery stores, and/or restaurants near your place of quarantine with
delivery services
(business names and addresses), etc.]:
✓
I will arrange getting over-the-counter medication without leaving my place of quarantine as follows
[Give details about the medication you have with you and the pharmacy (name and address) that
can deliver more if needed]:
✓
I have the following prescription drugs with me and enough for one month [If this applies to you,
give details about the prescription drugs you have with you]:
✓
I will have access to the financial resources I need for my quarantine as follows [Provide as much
proof as possible that you have immediate access to enough funds to cover for the cost related to
the quarantine period: bank account summary, credit card that has a sufficient limit and that works
in Canada, etc.]:
AGREEMENTS [Keep only the points that are relevant to your situation; you can add more if
necessary]
As I travel to my places of quarantine, I agree to:
Wear an appropriate non-medical mask or face covering during the journey, unless I am alone
in a
personal vehicle.
Practise physical distancing at all times and avoid stops and contact with others during the
journey.
In the places where I am staying, I agree to and confirm the following:
There are no vulnerable individuals (adults 65 and over or people who have health
conditions or
a weak immune system).
There are no health care workers.
If there are other people living in my place of quarantine: I will avoid contact with people who did not
5
travel with me; I will stay on my own as much as possible in my own room; I will minimize my movement
in common areas; I will minimize my contact with other people; and I will wear a mask if I have to come
within two metres of other people.
If I have to share a bathroom with other people, I will disinfect the surfaces of the shared
bathroom each time after I use it.
If I have to use other common areas, I will disinfect the surfaces of those areas after each use.
I will air out rooms I use, as much as possible.
I will not have any guests, even if I am outside and keep a distance of two metres or wear a
mask.
I will avoid using the shared spaces, such as lobbies, courtyards, restaurants, gyms, and pools, in
apartment buildings or hotels.
I will stay two metres apart from other people if I go out on my balcony or into my private
yard.
I will not share any personal items with others, including plates, utensils, glasses, towels,
sheets,
and clothing.
I will avoid contact with animals.
With regard to providing for myself, I agree to:
Use the home delivery service of a grocery store or pharmacy and maintain a contact-free
delivery of
two metres, if no one is helping me with my groceries or medication.
Maintain a contact-free delivery of two metres, if someone is helping me with my groceries or
medication.
During my quarantine, I agree to:
Use ArriveCAN or call 1-833-641-0343 to confirm that I have arrived at the address I provided
for my
quarantine, within 48 hours of arriving.
Use ArriveCAN or call 1-833-641-0343 to complete daily COVID-19 symptom self-assessments
during
my quarantine period.
Answer any phone calls from the Government of Canada from 1-888-336-7735.
Not leave my place of quarantine during the 14 days of isolation, except in an emergency, such as a
medical emergency or to travel directly from my first place of quarantine to my second after receiving
a negative test result from a COVID-19 test that will have been conducted upon arrival in Canada. In
the event of an emergency medical consultation, I will notify the emergency services and healthcare
personnel that I am currently in quarantine after arriving from abroad, and I will follow all their
instructions. In addition, I will wear a mask, practise physical distancing with others as much as
possible, and disinfect my hands regularly.
Have no scheduled medical-related appointments during the quarantine period.
Wash my hands often with soap and warm water for 20 seconds or with a solution
containing at
6
least 60% alcohol until my hands are dry, especially after eating, after using
the toilet, and
whenever my hands are dirty.
Avoid touching my face as much as possible. I will sneeze or cough into either a tissue or the
crook of
my arm, and I will blow my nose into a tissue. If I use a tissue, I will throw it into the
garbage and wash
my hands as soon as possible.
Isolate myself from others if COVID-19 symptoms appear and call the COVID-19 hotline
(1-877-644-4545) and follow the instructions given.
Undergo the COVID-19 tests required by the Québec government and federal government.
If you are exempted from quarantine:
I agree to comply with local, provincial and federal health measures.
I agree to wear the mask and respect the physical distance at all times in public places.
I agree to keep copies of my proof of vaccination for my first 14 days in Canada.
I agree to make a complete list of all persons with whom I will be in close contact for the first
14 days following my arrival in Canada.
In addition, I am aware that:
I could be checked on to make sure I am not breaking my quarantine. I could be moved to a
quarantine facility if I break my quarantine or if I test positive for COVID-19.
I will have to quarantine again for a new 14-day period if COVID-19 symptoms appear during
my quarantine, if I am exposed to COVID-19, or if I test positive for COVID-19.
My quarantine could be longer if the test result from the COVID-19 test conducted toward the
end of the quarantine arrives later than day 14 of my quarantine.
There are serious consequences for not abiding by the quarantine (a fine of up to $750,000, up
to six months of jail time, and, as a foreigner, being removed from Canada and banned from
entering for one year).
Failure to abide by the quarantine may constitute other criminal offences.
Name:
Date:
Signature:
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Suggested Quarantine Plan

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Completed 15 March 2022

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