Communicable Disease Assessment (CDA)

18226 (Rev2018-09) Page 1 of 3 Communicable Disease Assessment (CDA) 1. READ the information provided on this page and sign where indicated. 2. COMPLETE the form on pages 2 and 3 in full. 3. SUBMIT the completed form (all three pages) to Workplace Health & Safety (WHS). The form may be submitted two ways: Email the form to Communicable Disease Assessment : or Fax the form to: In accordance with Alberta Health Services (AHS) policy, all new AHS representatives (including employees, members of the medical and midwifery staff, volunteers) who will be working at a patient care location must complete and submit a Communicable Disease Assessment (CDA) form to Workplace Health and Safety (WHS). Failing to complete and submit the CDA form could result in having your employment offer withdrawn. Your personal and health information (including your Personal Health Number) on this form is collected under the authority of section 33(c) of the Freedom of Information and Protection of Privacy Act ( FOIP ) and sections 20(b), 21, and 27(1) and (2) of the Health Information Act( HIA ), respectively.

18226 (Rev2017-02) Page 3 of 3 Communicable Disease Assessment (CDA) How to Get Immunization Records If you do not have your records, you may be able to obtain them from the following:

Loading..

Tags:

  Assessment, Disease, Communicable, Communicable disease assessment

Information