Self-Isolation Plan Questionnaire

Persons arriving to Prince Edward Island may be required to present a self-isolation plan. Be prepared to answer the following questions or complete the Self-Isolation for Travellers form.

Self-Isolation Plan

In which county will you be isolating?

  • Kings
  • Queens
  • Prince

What is your isolation household type?

  • Private
  • Family Member
  • Commercial (ie hotel, BNB, etc)
  • Other (describe)

List information of all household members (i.e. living at the same address):

  • First name:
  • Last name:
  • Date of birth (yyyy/mm/dd):

Contact phone number while in isolation:

Contact person name while in Isolation:

Isolation address (if different than home address):

    Do you have transportation to your isolation premise?

    • Yes
    • No

    Do you have enough prescriptions for 14 days of self-isolation?

    • Yes
    • No
    • Not applicable

    Do you have enough supplies for 14 days of self-isolation (food, cleaning supplies, etc)?

    • Yes
    • No

    Do you have local support (childcare, dog walk, etc) for 14 days of self-isolation?

    • Yes
    • No
    • Not applicable

    Do you have oudoor plans? If so please describe.

    Are there any other details about your self-isolation plan we should know?

    Published date: 
    June 2, 2020
    Health and Wellness

    General Inquiries

    Department of Health and Wellness
    4th Floor North, Shaw Building
    105 Rochford Street
    Charlottetown, PE   C1A 7N8

    Phone: 902-368-6414
    Fax: 902-368-4121