Apply for Health Department approval to manage a corpse with a specific communicable disease

Management of corpses with specific communicable diseases

In accordance with O. Reg. 557, Communicable Disease - General, approval must be granted by the medical officer of health, in the health unit in which the person died, to manage the corpse of a person who was confirmed, suspected, or isolated for having: anthrax, Ebola virus disease, haemorrhagic fevers (other viral causes), Lassa fever, Marburg virus disease, plague, smallpox.

For approval by Durham Region Health Department, complete this application to request opening of a body bag/casket/container, removal, disinterment and/or shipment of the corpse of a person who was confirmed, suspected, or isolated for having one of the above listed communicable diseases.

Purpose of application (check all that apply)

Disinterment

Shipment/transportation

Removal of a deceased person

Other

Opening of a body bag/casket/container

Applicant/facility information

Business/facility name

Applicant first name

Applicant last name

Phone number

Email address

Facility/establishment type

Burial establishment

Transfer site/service

Funeral home

Other

Street address

City/Town

Postal code

Deceased individual and death information

Deceased first name

Deceased last name

Date of death

Cause of death

Infectious agent identified (check all that apply)

Anthrax

Plague

Ebola virus

Smallpox

Lassa fever

Haemorrhagic fever (other viral causes), please specify:

Marburg virus

Upload relevant files

Please note that our reporting system is unable to process attachment(s) larger than 14MB. If the total size of all uploads is greater than 14MB, you will need to reduce the file size prior to uploading.

Upload relevant files (e.g., death certificate, medical certificate of death, statement of death, cause of death, containment information, transportation information, etc.)

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Requirements of the funeral professional/facility with custody of the corpse

Containment requirements:

Two leak-proof body bags, each at least 150 µm (micrometer) thick.
Soundly constructed casket or cremation container (must be closed immediately after corpse is placed and not be opened except as directed by the Medical Officer of Health).
Hermetically sealed (requirement only for smallpox or anthrax).

Shipping/transportation requirements:

Corpse must be enclosed in soundly constructed casket or cremation container.
If the corpse is being transported or carried by commercial carrier of any kind, the casket or cremation container must be enclosed in an outer case that is sufficiently strong to ensure that the casket or cremation container and the hermetical sealing, if any, will not be broken throughout the transportation or carriage of the corpse by the commercial carrier.

Acknowledgement and confirmation of requirements and responsibilities

I acknowledge the containment and shipping/transportation requirements outlined above and confirm that the relevant requirements will be adhered to.

COLLECTION OF PERSONAL AND PERSONAL HEALTH INFORMATION
The personal and personal health information provided in this form is collected under the authority of section 5 of the Health Protection and Promotion Act and in accordance with O. Reg. 557. The information will be used for the following purposes: to prevent, eliminate and/or decrease the effects of a health hazard during corpse management, to process and follow up with your submitted application; and, to inform the delivery, evaluation and administration of the Infectious Disease Prevention and Control program. Information will be collected, used, and disclosed in accordance with the Personal Health Information Protection Act, 2004, S.O. 2004, c.3. Questions about this collection of information should be addressed to the Manager, Health Information, Privacy and Security at 605 Rossland Road E., P.O. Box 730, Whitby, ON, L1N 0B2.