Quarantine Regulations

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

Order of Detention in Quarantine

I, (full name of quarantine officer) 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) of (full address of person, if known) arriving in Canada at (full name of place of arrival in Canada) from (full name of place outside Canada) at (time of arrival in Canada on the (day of month) day of (month) (year) be detained for a period of (a period not exceeding 14 days) 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)

OR

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

Complete either C or D but not both

C (full name of person) 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) 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) (time) on the (day of month) day of (month) (year) .

Signature of quarantine officer

Full name of quarantine officer