Scribd
Upload
12 views2 pages

Quarantine Order Form-1-10

Tricia Mohan has been ordered to quarantine at home for three days due to a potential risk of transmitting the Novel Coronavirus, starting from March 26, 2022. During this period, she must not leave her home and will be monitored daily by a Surveillance Nurse. Non-compliance may result in a fine of $50,000 and imprisonment.

Uploaded by

raiddholder
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
12 views2 pages

Quarantine Order Form-1-10

Tricia Mohan has been ordered to quarantine at home for three days due to a potential risk of transmitting the Novel Coronavirus, starting from March 26, 2022. During this period, she must not leave her home and will be monitored daily by a Surveillance Nurse. Non-compliance may result in a fine of $50,000 and imprisonment.

Uploaded by

raiddholder
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

QUARANTINE ORDER FORM

Name: TRICIA MOHAN ID/DP/PP: 19811020024

Address: 74 REFORM VILLAGE, Age: 40

GASPARILLO. Gender: FEMALE

Nationality: TRINIDADIAN

Contact Number: 745-9106

Quarantine Directions:

1. You have been assessed as a possible risk for the transmission of the Novel Coronavirus. The
Chief Medical Officer of Trinidad and Tobago, who is the Quarantine Authority, in accordance
with the powers vested by the Quarantine Act, Chapter 28:05 and Regulations made thereunder,
specifically, Regulation 38(1)(b) of the Quarantine (Maritime) Regulations and Section 15 of
the Quarantine (Air) Regulations, has directed that you be quarantined in your home for
observation for THREE (3) days. with effect from: 26/03/22

2. You are not allowed to leave your home during this period and failure to comply with these
quarantine directions are liable on conviction to fine of $50,000 and imprisonment.

3. During your quarantine period, you will be contacted daily by a Nurse from the Surveillance
Unit of the County Medical Officer of Health.

4. The Surveillance Nurse will interview you to determine the presence of other symptoms and
guide you through the process of taking your temperature.
5. If you develop fever, cough, shortness of breath or difficulty breathing you will require
hospitalization and must immediately contact the Surveillance Nurse assigned to you.

6. You are to wear the prescribed Personal Protective Equipment (PPE) advised by the County
Medical Officer of Health or Public Health Inspector.

I have read, understood and I am willing to comply with the instructions stated above.

TRICIA MOHAN
NAME OF SUSPECTED / SIGNATURE OF SUSPECTED /
CONFIRMED COVID 19 PERSON CONFIRMED COVID 19 PERSON
(BLOCK LETTERS)

LA-KEACHER TEESDALE
NAME OF PROCESSING OFFICER SIGNATURE OF PROCESSING
(BLOCK LETTERS) OFFICER

NATASHA SOOKHOO
____________________________________
NAME OF COUNTY MEDICAL
OFFICER OF HEALTH SIGNATURE OF COUNTY MEDICAL
OFFICER OF HEALTH

DATE: 25/03/22

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy