To support your return to in-person University research activities either at a University research site or at
an off-campus research site, please read this form carefully. Your access to these research sites is
conditional upon your compliance with the statements below. Please submit this form to your
supervisor/Principal Investigator. Please note that you retain the right to choose whether to attend
campus or a third-party research site.
Student Name and Student Number
Student Contact Info (cell and email)
University Location (Building, Room)
Off-Campus Research Site (if applicable)
Supervisor/Principal Investigator
Academic Division/Department/Unit/School
A. Training and Compliance
I have read and will comply with the University’s entry poster located at:
content/uploads/2020/03/Restricted-Access-Poster_8.5x11_FA.pdf. I will
enter any research site if I answer YES
to any of the questions listed in the entry poster.
I will follow health and safety processes, procedures, policies and directives of the University or an off-campus
research site, if applicable, including participation in health and safety training and/or wearing a mask and/or
other PPE, if required to do so.
If I test positive for COVID-19, I will notify the University’s Occupational Health Nurse immediately by email
at and I will not visit any research site until I receive clearance to do so from the
University’s Occupational Health Nurse.
B. Public Health Best Practices
Until or unless I am otherwise notified by the University or the off-campus research site, if applicable, I will only
attend the University research site or off-campus research site, if applicable, for the minimum time required to
conduct my research.
In accordance with public health directives, I will avoid touching my face, nose or mouth with unwashed hands,
will wash my hands often and thoroughly with soap and water or alcohol-based hand sanitizer, will practice proper
respiratory etiquette, such as sneezing and coughing into my elbow, will refrain from shaking hands and will
maintain physical distancing of two metres or more.
I will immediately inform my Department/Unit or Academic Division if I become aware of circumstances that are
unsafe at the University research site or at the off-campus research site, if applicable.
I have read and agree to adhere to the requirements set out in this Acknowledgement.
Name Date
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