Quarantine Regulations

Version of the schedule from 2006-03-22 to 2006-12-11:


SCHEDULE II(s. 30)

Department of National Health and Welfare Medical Services Branch — Quarantine Service

Order of Detention in Quarantine

I, (full name of quarantine officer) blank line designated as a quarantine officer for the purposes of the Quarantine Act, do hereby order, with the approval of the Minister of National Health and Welfare, that (full name of person) blank line of (full address of person, if known) blank line arriving in Canada at (full name of place of arrival in Canada) blank line from (full name of place outside Canada) blank line at (time of arrival in Canada blank line on the (day of month) blank line day of (month) blank line (year) blank line be detained for a period of (a period not exceeding 14 days) blank line days.

Complete either A or B but not both

A in (name and address of quarantine station, hospital or other place having suitable quarantine facilities where person is to be detained)

blank line

OR

B on (name and location of vessel if person is arriving in Canada on a vessel) blank line for the reason that blank line

Complete either C or D but not both

C (full name of person) blank line refuses to undergo the medical examination requested by me pursuant to subsection 8.1(1) of the Act.

OR

D I suspect that (full name of person) blank line who has undergone a medical examination pursuant to subsection 8.1(1) of the Act has a disease, other than an infectious or contagious disease as defined in section 2 of the Act, the introduction of which into Canada would, in my opinion, constitute a grave danger to public health in Canada.

DATED AT (place) blank line (time) blank line on the (day of month) blank line day of (month) blank line (year) blank line .

blank line

Signature of quarantine officer blank line

blank line

Full name of quarantine officerblank line

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