Submitted to:
Respiratory Outbreak Team
Communicable Diseases Team
After-Hours
*
Select After-Hours ONLY if verbally directed by On-Call Staff
Submitted by:
Organization Name
Municipality
Burlington
Halton Hills
Milton
Oakville
First Name
Last Name
Position / Title at Organization
Phone number
(required)
Document 1
Document 2
Document 3
Document 4
Document 5
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Please ensure all required fields are completed. If you have any questions about the collection of personal health information, please call 311 or send an email to
accesshalton@halton.ca
.