COVID Risk Declaration

IUOE Local 955 Apprenticeship & Education follows strict COVID-19 virus prevention procedures and responsibilities. These have been developed in accordance with federal

and provincial public health recommendations and IUOE Local 955’s best practices. As such, these procedures may change as the pandemic evolves. This Risk Exposure

Declaration is part of our procedure and every student who attends a course is required to complete and submit this document when confirming attendance and again

during the course orientation.

Please read and answer all of the questions below.

  1. Are you currently experiencing any of the following symptoms?

   Yes (Check all that apply below):                                     No

              Cough

              Shortness of Breath

              Fever

              Difficulty Breathing     

  1. In the 14 days prior to the start of your course, have you or will you be scheduled to undergo a test to determine if you have been infected with COVID-19?

   Yes                                                                                   No

If yes, please provide test date/expected result date: ________________________.

  1. In the 14 days prior to the start of your course, have you have travelled outside of Canada?

   Yes                                                                                   No

  1. Have you been in close contact with a probable or confirmed case of COVID-19?

   Yes                                                                                   No

If you have been diagnosed with COVID-19, are awaiting a test result, or answered “yes” to any of the other above questions, you will not be permitted to attend a training course at this time.

You are also required to contact Alberta Health Services and complete the self-assessment. Please note that by signing this form, you are agreeing to disclose future potential illness or exposure to COVID-19 that may have or will occur during the time you are participating in training.

Please complete your contact information below:

Print your name: _________________________________

Employer name: _________________________________

Best way to contact you:  text______________________________ OR email______________________________________

Date: __________________

Your signature: ___________________________________