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Annex: Marine Vessel Communicable Disease Reporting Form

Quarantine Act Privacy Notice

The personal information provided is collected under the authority of the Quarantine Act. The information may be used by the Public Health Agency of Canada to administer and enforce the Quarantine Act and may be disclosed, as permitted by law, to prevent the introduction and spread of communicable diseases. For more information, refer to the personal information bank PHAC PPU 071 at

Failure to provide the requested information may be punishable by law and can result in monetary fines, imprisonment or both, and vary dependent on the section contravened.

You have the right to access and request a correction and/or notation to your personal information. 
For more information about rights under the Privacy Act, contact You also have the right to file a complaint with the Privacy Commissioner of Canada at
For more information about the Quarantine Act, please visit


1. The Public Health Agency of Canada (PHAC) requires that marine vessels report cases of communicable disease amongst passengers and crew upon entering and departing Canada pursuant to section 34 of the Quarantine Act. 


When to Report to PHAC:


I.   if a traveller meets the syndromal case definition:

traveller has a fever of 38°C or greater or two (2) or more signs of fever, such as:

  • shivering
  • flushed skin
  • excessive sweating
  • complaints of feeling feverish

AND has one (1) or more of the following symptoms:

  • difficulty breathing
  • repeated cough
  • diarrhea
  • headache
  • recent confusion
  • skin rash
  • bruising or bleeding without previous injury

II.    also notify PHAC if:

  • traveller has tested positive to a communicable disease listed under the Schedule of the Quarantine Act
  • traveller appears obviously unwell
  • traveller has a cough with blood
  • death on board
  • human remains are identified on board 


*Should any traveller meet syndromal case definition, a Quarantine Officer will initiate a health assessment. This requires the operator to complete the Annex. If further assessment is required, a Quarantine Officer will contact the operator directly.  

2.    If the link to submit the Annex is not operational, marine operators may request and complete the PDF version of the annex, along with the Excel Case Reporting Form to the following email: