Before completing this form, please ensure you have submitted form A. 2021 Isolation Plan Application for Seasonal Agriculture Workers and have received approval. This form is to be used only as an appendix to an approved Isolation Plan, where subsequent arrivals of seasonal agriculture workers shall be isolating in that unit.
By clicking “submit” at the bottom of this page, this appendix to application form is submitted to the Haldimand-Norfolk Health Unit electronically. You will receive a confirmation email indicating that the appendix has been received, which will include a copy of your completed form. Please print the completed form for your records. A Public Health Inspector will then review your application and will be in touch with you.
If you wish to print the form, you may use the PDF version.
If you have any questions regarding the completion of this form, please contact the EHT Hotline at:
519-426-6128. Leave a message and your call will be returned.