Fillable Brandon University COVID-19 Informed Consent and Campus Eligibility (Brandon University)

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Brandon University COVID-19 Informed Consent and Campus Eligibility (Brandon University)

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Country of origin: CANADA
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Please initial the following statements to declare that you understand and accept these risks.
I UNDERSTAND THAT:
COVID-19 has been declared a worldwide pandemic by the World Health
Organization and that COVID-19 is extremely contagious and can spread by
person to person contact
By participating in Brandon University activities I may become infected with
COVID-19, which could result in the following: extended quarantine/self-isolation,
additional tests, hospitalization that may require medical therapy/intervention,
intensive care treatment, possible need for intubation/ventilator support, short-
term or long-term intubation, other potential complications (including lung and
heart complications) and the risk of death.
COVID-19 might cause additional risks, some of which may not currently be
known at this time.
These risks could cause me to incur medical and other expenses.
Manitoba is under a province-wide state
of emergency to protect everyone’s health
and safety and to reduce the spread of
the novel coronavirus, which causes a
disease known as COVID-19. This highly
infectious disease is easily spread, and it
can cause serious illness and even death.
While it is impossible to eliminate all
risk, Brandon University has put in
place measures designed to limit and
reduce the spread of COVID-19. These
measures include increased cleaning
and sanitization, plastic barriers, limited
campus access with reduced classroom and
lab capacity, mandatory masks, and more.
By coming to the Brandon University
campus, by using Brandon University
facilities, or by participating in activities
organized by Brandon University,
whether on-campus or off-campus
(including student internships and
placements) you may be exposed to
COVID-19 and could contract it yourself.
BrandonU.ca/Coronavirus
ALL STUDENTS MUST READ BOTH PAGES, INITIAL EACH POINT
AND SIGN BEFORE COMING TO CAMPUS
CONTINUE TO NEXT PAGE
Brandon University
COVID-19 — Informed Consent and Campus Eligibility
Your success is important to us. If you become ill or otherwise ineligible to attend campus, please as
soon as possible contact your instructor and/or the building office where you require access, so that
we can make alternative arrangements to support you.
BrandonU.ca/Coronavirus
PLEASE INITIAL ALL CHECKBOXES ON BOTH PAGES, THEN FILL AND SIGN BELOW
Name:
This document must be returned to CovidCampusAccess@BrandonU.ca before you attend campus.
Date:
Student No:
Print Name Signature or Digital Signature
Brandon University
COVID-19 — Informed Consent and Campus Eligibility
Please initial the following statements to certify that you are eligible to attend campus.
I CERTIFY THAT:
Brandon University has put in place
measures designed to limit and reduce
the spread of COVID-19. To help us, we
ask you to assess your own individual risk
factors as well, and we are prohibiting
campus access to those at higher risk.
It is your responsibility to always know
the current public health guidance related
to COVID-19 in Manitoba. This includes
physical distancing, group size limits,
common symptoms, and behaviours like
hand-washing and wearing masks.
These guidelines continue to change
and you should continue to monitor the
most recent official information from
the Province of Manitoba. Thank you
for helping us keep you, and everyone on
campus, as safe as possible.
CONTINUED FROM PREVIOUS PAGE
No one in my househould, including me,
has been exposed to COVID-19, nor
diagnosed with COVID-19
No one in my household, including me, is being directed to self-isolate.
I am following all current public health guidelines as much as possible.
I will continue regular self-monitoring for symptoms or other COVID-related risk
factors.
If my circumstances change, I will notify Brandon University immediately, either
through my instructor or to the main office of the building I attend.
Use one of these email addresses: Arts
@
BrandonU.ca • Education
@
BrandonU.ca • HealthStudies
@
BrandonU.ca
Music@BrandonU.ca • Science@BrandonU.ca • Library@BrandonU.ca • Residence@BrandonU.ca
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Brandon University COVID-19 Informed Consent and Campus Eligibility (Brandon University)

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Completed 30 January 2021

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