Canadian Armed Forces Travel Screening Declaration
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PROTECTED A (When completed) Last name First name SN Date (yyyy-mm-dd) PROTECTED A (When completed) Canadian Armed Forces Travel Screening Declaration Signature of Passenger / Screener Email Address (at destination) Telephone (at destination) Home Unit/Employer Point of Contact (Home Unit/Employer) Section B: Declaration Date (yyyy-mm-dd) • Do you currently have new/worse cough, shortness of breath, or sore throat? • Have you had a new loss of smell or taste in the last 14 days? • Are you feeling feverish or have you had shakes or chills in the last 24 hrs? • If you have recently checked your temperature, was the temperature reading above (100.4°F) 38°C? • Do you currently have nausea, vomiting, abdominal pain and/or diarrhea? • Are you currently feeling very unwell, confused or tired? • Do you currently have muscle or body aches? • Within the last 14 days did you provide care to, or have close contact with, a symptomatic person known or suspected to have COVID-19? • Are you awaiting COVID-19 test results? If you answered "Yes" to any of the questions above, do NOT travel. Contact your health care provider for further advice prior to travel. Flight Number Row Number and Seat Letter I acknowledge that I am to quarantine for 14 days after travel if required by my employer or Federal, Provincial or Host Nation governments. I hereby acknowledge that I have read, understand and agree to the terms in this document. Should symptoms such as a fever, cough or difficulty breathing develop while in flight, I will notify the flight crew or medical provider immediately. Postal Code (at destination) Section A: COVID-19 Symptom Self-Assessment All travellers (travel to, from, or within Canada) must complete the self-assessment on-line at https://ca.thrive.health/covid19/en on the day of travel. Complete the ‘Government of Canada Self-Assessment Tool’ option. If your assessment tells you to quarantine/isolate do NOT travel and contact your local Canadian Forces Health Services Centre (CFHSC) for further advice. All passengers must read, understand and answer the questions below prior to flight. This can be done online or in person. Please bring a printed copy of your completed form with you to the passenger terminal. This form will be collected by the Loadmaster and retained for 2 weeks following completion of the Christmas Flight Program in order to facilitate contact tracing if required.
Transcript of Canadian Armed Forces Travel Screening Declaration
PROTECTED A (When completed)
Last name First name SN
Date (yyyy-mm-dd)
PROTECTED A (When completed)
Canadian Armed Forces Travel Screening Declaration
Signature of Passenger / Screener
Email Address (at destination) Telephone (at destination) Home Unit/Employer Point of Contact (Home Unit/Employer)
Section B: Declaration
Date (yyyy-mm-dd)
• Do you currently have new/worse cough, shortness of breath, or sore throat?• Have you had a new loss of smell or taste in the last 14 days?• Are you feeling feverish or have you had shakes or chills in the last 24 hrs?• If you have recently checked your temperature, was the temperature reading above (100.4°F) 38°C?• Do you currently have nausea, vomiting, abdominal pain and/or diarrhea?• Are you currently feeling very unwell, confused or tired?• Do you currently have muscle or body aches?• Within the last 14 days did you provide care to, or have close contact with, a symptomatic person known or suspected to
have COVID-19?• Are you awaiting COVID-19 test results?
If you answered "Yes" to any of the questions above, do NOT travel. Contact your health care provider for further advice prior to travel.
Flight Number Row Number and Seat Letter
I acknowledge that I am to quarantine for 14 days after travel if required by my employer or Federal, Provincial or Host Nation governments.
I hereby acknowledge that I have read, understand and agree to the terms in this document. Should symptoms such as a fever, cough or difficulty breathing develop while in flight, I will notify the flight crew or medical provider immediately.
Postal Code (at destination)
Section A: COVID-19 Symptom Self-Assessment
All travellers (travel to, from, or within Canada) must complete the self-assessment on-line at https://ca.thrive.health/covid19/en on the day of travel. Complete the ‘Government of Canada Self-Assessment Tool’ option. If your assessment tells you to quarantine/isolate do NOT travel and contact your local Canadian Forces Health Services Centre (CFHSC) for further advice.
All passengers must read, understand and answer the questions below prior to flight. This can be done online or in person. Please bring a printed copy of your completed form with you to the passenger terminal. This form will be collected by the Loadmaster and retained for 2 weeks following completion of the Christmas Flight Program in order to facilitate contact tracing if required.
