MY SELF-ISOLATION PLAN

Name

Destination City

How I will travel to my destination:

I have arranged for a car rental I have arranged for a limousine pick up at the airport I am travelling in my own vehicle

Accommodation at my destination:

Address

I will be living at this address for 14 days, from __________________ to ______________

I have ensured that there are no persons vulnerable to COVID-19 at the pace where I will live. Including those who have an underlying medical condition, compromised immune system from a medical condition or treatment, or are 65 years of age or older.

What I will do in case of symptoms:

If I start having symptoms of COVID-19 (cough, shortness of breath, or fever equal to or greater that 38 C, or signs of a fever (eg. Shivering, flushed skin, excessive sweating), I will immediately call the public health authority, and follow their instructions.

Telehealth Ontario: 1-866-797-0000

My understanding of the self-isolation requirements:

I understand that self-isolation requires me to not be in physical contact with any persons in connection with my employment or in the community while in self-isolation. I have read the information on self-isolation at https://www.canada.ca/en/public-health/services/publications/diseases-conditions/2019-novel-coronavirus-information-sheet.html

May 2020

MY SELF-ISOLATION PLAN

Signature:

May 2020