The report, prepared by the province's deputy chief medical officer, says it will take time, effort and investment to put measures in place to protect the public's health.
"As others have noted, the (oil and gas) resources have been in place for millennia and are not going to disappear any time soon," Frank Atherton says in the report, released late Monday.
"In the interests of public health, Nova Scotia should take the time and make the necessary investments to ensure that proper regulation, management, mitigation and monitoring measures are established."
Barb Harris, a spokeswoman for the Environmental Health Association of Nova Scotia, lauded Atherton's cautious approach.
"I think he's being really honest that we know about some risks, but we don't know about others, and that some of what we don't know could be extremely serious," said Harris, an environmental health researcher.
"I think what Dr. Atherton is hinting at ... is that there's another option, which is slow down."
The association is calling for a 10-year moratorium on hydraulic fracturing, which Harris says would give the province enough time to set up proper regulations, monitoring and enforcement.
"It's important because this is a relatively new industry," Harris said Tuesday. "It's not just how close (these wells) can get to homes, it's the scale of the industry. It spreads all over the place. ... And you can't do serious monitoring without investing a lot of money into it."
In 2012, the Nova Scotia government placed a two-year moratorium on hydraulic fracturing, saying it needed more time to study the rapidly growing industry. It appointed a panel of experts to seek public input and make recommendations through a series of reports.
Atherton's go-slow approach mirrors a key recommendation made in April by a panel of top Canadian scientists. Their report concluded that little is known about the long-term impact of extracting oil and natural gas by fracturing rock formations with high-pressure fluids.
The independent Council of Canadian Academies said even though the economic benefits could be significant across Canada, it found significant uncertainty on the risks to the environment and human health.
Atherton's report cites the council's work and concludes that "the science of hydraulic fracturing is relatively new ... and that neither the benefits nor the harms to health and the environment are fully known and may not be fully knowable for many years or even decades."
He provides a long list of potential health hazards associated with the unconventional oil and gas extraction, including contamination of groundwater, air pollution, surface spills, increased truck traffic, industrial accidents and generation of greenhouse gases.
The Nova Scotia report also cites the psychological harm and social disruption that can occur when a sudden influx of industry investment leads to a so-called "boomtown effect" — a key warning in a report produced by New Brunswick's medical officer of health in a 2012 report.
Among the 15 recommendations in his report, Atherton says more long-term study is needed on health impacts and environmental monitoring.
As well, he says energy companies should be obliged to publicly release lists of the chemicals used in hydraulic fracturing, and they should pay for health impact assessments at each well site.
He is also calling for updates for traffic management and new standards for noise, odour, vibration and light pollution.
Hydraulic fracturing has been used in one form or another since the late 1940s, but environmentalists say they are more concerned about a relatively new process known has high-volume fracking in shale deposits, which was first used in Canada in 2005.