PEI Self-Isolation Declaration

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This is a declaration for persons planning to travel to PEI or returning to PEI, who are required to self-isolate. See information about who is required to isolate on the COVID-19 Self-isolation webpage.

Travel categories in this form are:

  • Permanent PEI resident 
  • Non-PEI resident
  • Non–PEI resident student

Everyone completing this form should read the Self-Isolation page and the PEI Self-Isolation Declaration webpage prior to completing this declaration.

This form can be completed by:

  • An adult (18 or older) on their own behalf. 
  • An adult on behalf of a household who are arriving together and isolating together at the same location. A "household" is defined as "persons who normally reside together at a residence". 
  • A parent or guardian on behalf of a minor (under age 18) who is travelling alone to PEI.

Notes: 

  • If members of a household are self-isolating at different locations in PEI, or arriving to PEI at different times they must complete separate forms.
  • If people from different households are travelling and isolating together in PEI, they are required to submit separate forms.

Personal information on the PEI Self-Isolation Declaration is collected to record the isolation plans of PEI residents returning from outside of the province and others entering the province who are required to self-isolate in order to decrease the risk to public health in Prince Edward Island during the COVID-19 public health emergency and to enforce self-isolation exemptions. This collection is authorized by the Public Health Act, section 56 and the Freedom of Information and Protection of Privacy Act, section 31. For more information contact Justice and Public Safety at publicsafety@gov.pe.ca or 902-368-5025 (Monday to Friday 8am-8pm; Saturday and Sunday 8am-4pm).

Identification
Name(s) provided should be the same as the one on your identification. Provide your current home address in the fields below. See below to add additional members of your household travelling and isolating with you.
For example C1B 0X1 or 12345
For example 902-555-5555
You must provide all names of the people in your household travelling and isolating with you (adults and children):
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