Quarantine Plan - Northeastern University - Toronto Campus

As communicated previously, you will be required to make arrangements for a 14-day quarantine
period on arriving in Canada. Please complete this form and sign it to attest that you will comply
with all pre and post arrival requirements. A quarantine plan will also be requested by CBSA, who
may ask for further documentation of these arrangements, such as proof of pre-payment, booking
confirmations, etc. Once reviewed, no changes are permitted, except those beyond your control,
such as a flight delay or change.
In-Canada Contact Information
Date of
Full Name: Birth:
Last First M.I. (YYYY/MM/DD)

Address:
Street Address Apartment/Unit #

City Province Postal Code

Phone: Email:

NU Student ID Number:

Travel Information

Airport of Arrival/Terminal:
Arrival Date:
Accompanying Family Members:
Airline / Flight Number:

(please list)
Quarantine Plan
Do you have accommodation where you YES NO If “NO", please refer to the instructions on
can quarantine for 14 days? how to book the NU-arranged hotel service.

If “YES”, please PRIVATE WITH HOTEL HOTEL NU OTHER -

identify the type: RESIDENCE FAMILY SELF ARRANGED ARRANGED EXPLAIN:

Please give the address of the quarantine accommodation:

Hotel Name Street Address Apartment/Unit #

City Province Postal Code

Does any member of your travel party, or anyone you are staying with during
quarantine have any health condition that may put them at a higher risk of illness YES NO
due to Covid 19, such as a compromised immune system, cancer or recent cancer I

treatment, diabetes, high blood pressure, lung disease, or is over the age of 65?

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 Have you made the necessary arrangements to ensure that you can access YES NO
food and other basic needs during your quarantine period?

FRIENDS/ FAMILY
If “YES”, how will you DELIVERY MEAL PLAN TO PROVIDE OTHER
receive these necessities?
If you do not use the hotel we have arranged, we require proof of your arrangements. Please provide proof of your
booking, or a contact for your relative or friend you will be staying with. We will be contacting them to verify.
Please note that you are required use Red Car service as your transportation from the airport.
You should not arrange to have your relatives or friends meet you at the airport. Instructions for booking the service is
on the Pre-Arrival Checklist. The cost will be paid for by Northeastern University.

Additional Information
If you have any other details that you would like to include for your quarantine plan, please add them here.

Quarantine Hotel Arrangements

The Toronto campus has arranged quarantine accommodation at the Holiday Inn Express Toronto Downtown (111
Lombard St, Toronto, ON M5C 2T9). This accommodation option provides each student or student family unit with
a private room and private bathroom. The hotel quarantine policies and services include the following:
 Total Isolation: Guests are not permitted to leave their rooms, except in an emergency and during their
designated outdoor time.
 Contactless check in procedure.
 Food Delivery: Guests will be delivered food to their room door. Holiday Inn Express Toronto Downtown has
partnered with a local caterer to provide lunch and dinner. Breakfast is provided by the Holiday Inn Express
Toronto Downtown.
 Replenishment: Room Attendants will replenish towels and linens throughout stay but will not enter the rooms.
Bags will be provided for guests to put dirty linens and towels in for Room Attendants to collect outside of the
rooms.
 Cleaning: Supplies will be made available for cleaning, including garbage bags for waste.

Please refer to the accompanying flyer for booking instructions and rates. This is the hotel that will be used
for students who do not have adequate plans for their quarantine period. All hotel charges are the
responsibility of the student.

Attestation for Quarantine Plan

I attest that this information is correct to the best of my knowledge and shared for the purpose of communicating my
quarantine plan. I agree to abide by this quarantine plan (including pre-arrival requirements), adhering to all applicable
laws, including the Quarantine Act and all rules and regulations related and admission.

I acknowledge that I will be monitored by Public Health and a designated representative of Northeastern University
regularly during my quarantine period. Should I be found to be in breach of this plan or any rule or regulation, I
understand that this information will be shared with the Government of Canada and local health authorities.

Signature: Date:_______ ____

(YYYY/MM/DD)
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