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PLF 31 May-2012

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Public Health Passenger Locator Form: To protect your health, public health officers need you to complete this form whenever they suspect a communicable disease onboard a flight. Your information will help public health officers to contact you if you were exposed to a communicable disease. It is important to fill out this form completely and accurately. Your information is intended to be held in accordance with applicable laws and used only for public health purposes. ~Thank you for helping us to protect your health. One form should be completed for each individual traveller. An adult member of the group should fill in the form for children who are too young to do so.

Print in capital (UPPERCASE) letters. Leave blank boxes for spaces. FLIGHT INFORMATION: 1. Airline name 2. Flight number 3. Seat number 4. Date of arrival (yyyy/mm/dd) PERSONAL INFORMATION: 5. Last (Family) Name 6. First (Given) Name 7. Middle Initial 8. Your sex PHONE NUMBER(S) where you can be reached if needed. Include country code and city ...

  Family, Leave

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