A-515 Common Travel Area Declaration Form

Appendix "A"
Nunavut and Northwest Territories Common Travel AreaNunavut and Churchill, Manitoba Common Travel Area Traller's Declaration

Background

1. The Chief Public Health Officer of Nunavut, in partnership with the Chief Public Health Officers of the Northwest Territories and Manitoba has established two Common Travel Areas:

a. The Nunavut and Northwest Territories Common Travel Area; and
b. The Nunavut and Churchill, Manitoba Common Travel Area.

2. This allows unrestricted travel between Nunavut and the Northwest Territories or between Nunavut and Churchill, Manitoba for anyone who has not travelled outside Nunavut or the Northwest Territories in the fourteen (14) days prior to travel and who have completed any mandatory self-isolation ordered by the Chief Public Health Officer of Nunavut, the Northwest Territories, or Manitoba.
3. Travellers who do not leave a Common Travel Area do not have to isolate prior to their return home.
4. If you leave a Common Travel Area at any time you will have to isolate at a designated facility prior to returning home.
5. The Nunavut and Churchill, Manitoba Common Travel area includes overland travel through unpopulated areas between the Nunavut-Manitoba boundary and Churchill.
6. All 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.
7. A parent or guardian may complete the declaration on behalf of their minor children.
8. Making a false declaration is a breach of the Travel Restriction Order.

Declaration of Traveller

1. I,

2. I have been physically present within the boundaries of Nunavut, the Northwest Territories, or Churchill, Manitoba for the past fourteen (14) days.
3. I will not leave the following Common Travel Area during my trip (check the appropriate box):

a. Nunavut and Northwest Territories Common Travel Area
b. Nunavut and Churchill, Manitoba Common Travel Area

4. I acknowledge that if I leave the Common Travel Area at any time during my trip, I will have to isolate at a designated facility for at least fourteen (14) days before I can return to Nunavut or the Northwest Territories, and will be responsible for arranging and paying to travel to a designated facility.
5. I consent to the collection of the Contact Tracing Information set out below.

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. This information may be shared with the Chief Public Health Officer of the Northwest Territories or the Chief Public Health Officer of Manitoba.

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.