A-513 Exemption for Fully Vaccinated Travellers Declaration Form

A-513 Exemption for Fully Vaccinated Travellers Declaration Form

Exemption for Fully Vaccinated Traveller's Declaration

Exemption for Fully Vaccinated Traveller’s Declaration

If you are fully vaccinated, you may choose to be exempted from the isolation requirement under the current Nunavut Travel Restriction Order. You are considered fully vaccinated two weeks after the final dose of COVID-19 vaccine.

All vaccinated travellers intending to travel to Nunavut must complete this declaration and submit it to @email in order to receive a letter of authorization permitting travel and present it to the air carrier upon check-in for verification.

Travellers must a sign a legally-binding declaration of vaccination stating they are fully vaccinated with a Health Canada approved vaccine. Declarations will be audited on a regular basis to verify compliance and false declarations may result in fines.

All travellers entering Canada must follow requirements under the current federal quarantine program before applying to come to Nunavut.

Did you receive your vaccine in Nunavut?

*If you were not vaccinated in Nunavut, you must provide verifiable evidence to the Department of Health, through @email, showing that you are fully vaccinated with a Health Canada approved vaccine. Your exemption request will not be processed until you provide evidence of vaccination.

Declaration of Traveller

1. I,

(Nunavut Community)
(date)
    1. I am fully vaccinated. I understand that I am fully vaccinated two weeks after the final dose of a Health Canada approved COVID-19 vaccine.
    2. I understand I may be asked to provide proof of vaccination during my travels (i.e., your vaccine card)
    3. I understand that making a false declaration is a breach of the Travel Restriction Order and I could be fined $575.
    4. I understand that I may be asked to isolate upon my return to Nunavut. These reasons may include:
    5. a. I am waiting for a COVID-19 test result;
      b. I am a contact of COVID-19; or
      c. I have been diagnosed with COVID-19.

    6. I understand that if I am isolating for any of these other reasons, I follow the instructions given to me by the Department of Health.
    7. I understand that I must wear a mask for 14 days upon arrival in Nunavut, regardless of current public health measures in my destination community.

    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.

    Traveller's Information
    (The name and community of the Traveller’s tourist accommodation is acceptable)
    (date)
    (community)
    Sign above

    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 @email.

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