Self-Isolation Plan Questionnaire

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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?

    Date de publication : 
    le 2 Juin 2020
    Santé et Mieux‑être

    Renseignements généraux

    Ministère de la Santé et du Mieux-être
    Immeuble Shaw, 4e étage (nord)
    105, rue Rochford
    Charlottetown (Î.-P.-É.) C1A 7N8

    Téléphone : 902-368-6414
    Télécopieur : 902-368-4121

    DeptHW@gov.pe.ca