Fill - Free fillable BCCOVID19RapidAntigenScreeningProgramAcknowledgement MyorganizationisarecipientofCOVID19RapidTestKitsandrelatedmaterialsfornon diagnostic screening in the workplace, pursuant PDF form

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BCCOVID‐19RapidAntigenScreeningProgramAcknowledgement

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MyorganizationisarecipientofCOVID‐19RapidTestKitsandrelatedmaterialsfornon‐

diagnostic screening in the workplace, pursuant to the TERMS AND CONDITIONS for

WorkplaceScreeningforSMALLtoMEDIUMORGANIZATIONSbetweenmyorganization

andHerMajestytheQueeninrightofCanada,asrepresentedbytheMinisterofPublic

WorksandGovernmentServicesandtheMinisterofHealth.



Under the TERMS AND CONDITIONS for Workplace Screening for SMALL to MEDIUM

ORGANIZATIONS my organization is required to ensure that the test kits and related

materials will be used, at all times, in compliance with applicable federal laws and

regulations, and laws, by‐laws,regulations,ordersandguidelinesenacted or issued by

municipal, regional, provincial or federal authorities, including health, safety and

environmentallaws,regulations,by‐laws,ordersandguidelines(the“ApplicableLaws”).

One of the Applicable Laws is theBC COVID‐19 Rapid Antigen Screening Program

Guidelines,Requirements,andStandardOperatingProcedures,Version1.5datedAugust

20,2021(“BCCOVID‐19RapidAntigenScreeningProgramGuidelines”).



Pursuanttomyorganization’sforegoingobligationundertheTERMSANDCONDITIONS

forWorkplaceScreeningforSMALLtoMEDIUMORGANIZATIONSIacknowledgethatmy

organization is required to comply with the BC COVID‐19 Rapid Antigen Screening

ProgramGuidelines,subjectonlytothefollowingamendment:



 Reportingoftestkitusage,willbedirectlythroughHealthCanada.

Bysigningbelow,Iconfirmthatmyorganizationhaveread,understandsandagreesto

complywiththeBCCOVID‐19RapidAntigenScreeningProgramGuidelinesincludingany

updatesontheBCCentreforDiseaseControlwebsite.

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Name:___________________________

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Signature:________________________

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Title/Role:________________________



Organization:_____________________

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Date:____________________________



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