Travel Declaration Form

Please submit your Travel Declaration Form within 48 hours of the expected travel date to ensure accuracy of the information. Submitted forms cannot be edited and a new submission will be required if your travel details change.

Arrival Type

All travelers from Newfoundland and Labrador will also have to fill out this form

1. Traveller Information

Expected Date of Travel

Last Name

First Name

Middle Initials

Email

Date of Birth

Cellphone Number

Alt Telephone

Address

City/Town

Prov/State

Country

Postal Code/Zip Code

Arriving From City/Town

Arriving From Prov/State

Arriving From Country

Have you traveled outside Canada in the 14 days prior to your expected travel date?

Yes
No

Are you a rotational worker?

Yes
No

Please provide Company name

Please List Those Travelling With You (living at the same address):

Name

Date of Birth

+ -

2. Duration of Travel

How long will you be in Newfoundland and Labrador?

Less than 24 hours
1 - 2 days
3 -13 days
14 days or more

3. Permissions to Enter the Province

Atlantic Province Resident (NL, NS, PE, NB)

Have you traveled outside Atlantic Canada in the 14 days prior to your expected travel date?

Yes
No

Essential Worker

Please provide Company name

Pre-approved travel exemption by Chief Medical Officer of Health (To submit a travel exemption go to https://www.gov.nl.ca/covid-19/exemption-application-form/)

I understand I should complete the on-line self-assessment tool at https://www.811healthline.ca/covid-19-self-assessment/ or call 811 if I develop even mild symptoms of 2 or more of the following (new or worsening): Fever (or symptoms of fever such as chills, sweats, muscle aches and light headedness), cough, headache, sore throat, painful swallowing, runny nose, unexplained loss of appetite/diarrhea, loss of sense of smell or taste OR experiencing small red or purple spots on the hands and/or feet.

I certify that my declaration is true and complete, and those who have travelled with me and I will abide by it. I acknowledge the importance of complying with the orders and that if I do not comply, this is an offence for which I may face a fine of $500 to $2,500, or jail time up to 6 months, or both a fine and jail time pursuant to section 35 of the Public Health Protection and Promotion Act.

Please contact healthinfo@gov.nl.ca if you have any questions regarding the collection and use of your personal information.

Submit