Health and Safety protocols for Contractors/Volunteers & Residential Access

The information collected in this form will be used in accordance with City of Airdrie's obligations to provide a safe workplace for staff, contractors and visitors on City worksites.

We require you to fill out the below questionnaire to assist in determining your fitness to work in our facilities.

Please ensure you are following safe work protocols for all known hazards in the workplace as identified on your field level hazard assessment and your employer's health and safety protocols.

The information collected in this form is collected under the authority of Section 33(c) of the Freedom of Information and Protection of Privacy Act (the "Act") and will be used solely for the purposes of the employee health assessment. It will be treated in accordance with the privacy protection provisions of Part 2 of the Act. Questions concerning collection of this information can be directed to Tammy Belsham, FOIP Coordinator or Shawn Justus, Health, Safety and Security Team Leader at 403.948.8800. City Hall, 400 Main St S, Airdrie, AB T4B 3C3.

Updated July 7, 2021

Please select all City of Airdrie facilities you will be accessing from the list below

• If there are any COVID protocols currently in place, are you familiar with these requirements and agree to adhere to them?

• Are you aware of the Emergency Response plan and muster point of the City facility you are working in?

• Are you trained and competent to complete the tasks relating to the work you are hired to perform?

• Do you understand your role and responsibility as per the OHS Act, Regulations and Code?

I am able to answer YES to all of the above questions and I declare that any employee doing business with the City is meeting the requirements.
I would answer NO to one or more of the above questions.