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2021 Isolation Plan Application for Seasonal Agriculture Workers

Please review the 2021 Seasonal Agriculture Worker COVID-19 Program Guide for requirements before completing this application. You must submit one application for each residence you plan to use to house seasonal agriculture workers during their isolation period.

Please complete Section 2 based on the known waves of worker arrivals that you are expecting. If you later learn of additional arrivals, you must submit Appendix A to 2021 Isolation Plan: Additional Arrivals of Season Agriculture Workers, in order to receive Health Unit approval.

By clicking “submit” at the bottom of this page, your application form is submitted to the Haldimand-Norfolk Health Unit electronically. You will receive a confirmation email indicating that your application 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.