Fillable Organization Request for Rapid Testing Devices (Alberta Student Aid)

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Organization Request for Rapid Testing Devices (Alberta Student Aid)

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Country of origin: CANADA
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10025 Jasper Avenue NW
PO Box 1360 Stn Main
Edmonton, Alberta T5J 2N3
Canada
www.health.alberta.ca
Classification: Protected A
Organization Request for Rapid Testing Devices
Submission template
Thank you for your interest in providing asymptomatic rapid screening for COVID-19 in Alberta.
Please complete the following information to formally submit a request for rapid tests. Your
submission will be reviewed by Alberta Health and you may be contacted by an Alberta Health
representative for additional information.
Section 1: Organization information
Please provide more information about your organization.
Organization Name (Corporate Entity for
Legal Agreement)
Location (s)
Key contact (please provide a phone
number and email)
Name:
Job Title:
Phone:
Fax:
Email:
Key contact for legal agreement execution
with Alberta Health
(if different than above)
Name:
Job Title:
Phone:
Fax:
Email:
Organization’s primary business
10025 Jasper Avenue NW
PO Box 1360 Stn Main
Edmonton, Alberta T5J 2N3
Canada
www.health.alberta.ca
Classification: Protected A
Section 2: Screening project details
1. Provide a high-level description of the screening program, including the screening setting.
2. List the physical locations where screening will be performed.
Name of location Address
3. Provide a description of the population to be screened (e.g., employees).
4. Provide the number of individuals to be screened.
5. Describe the frequency that each individual will be screened (e.g., once a week).
6. Provide the number of tests requested per month.
10025 Jasper Avenue NW
PO Box 1360 Stn Main
Edmonton, Alberta T5J 2N3
Canada
www.health.alberta.ca
Classification: Protected A
7. Provide the number of months the screening program will be run (maximum up to December
2021).
Screening process
8. Provide an overview of the screening processes. This includes details on eligibility criteria
(including screening for symptoms and exposure to COVID-19), when and where screening will
occur, how it will be conducted, who will be conducting it (sample collection, screening,
interpreting and communicating results), and how results will be delivered. You can attach
supporting information such as SOPs if required (please refer to appropriate page number or
section).
Section 3: Positive case management
9. Test results must be communicated confidentially to each individual by the trained test
administrator or a designated individual, such as a manager or person responsible for overseeing
the rapid testing program. Messaging delivered to individuals must include the following
information:
Your Rapid Test for COVID-19 was positive. These results are considered preliminary and
require further confirmatory testing through a public health lab. Please arrange for a
COVID-19 test through Alberta Health Services. Appointments can be booked by calling
811. Because of this preliminary positive result, you are legally required to isolate for 10 days
or until you are tested through a public health lab receive a negative result and have not
developed any symptoms.
Your Rapid Test for COVID-19 was negative. Rapid tests are not as accurate in people
without symptoms and a negative result does NOT rule out COVID-19. You must continue
to follow all public health guidelines.
If you have additional comments on delivering results, please provide them below:
10025 Jasper Avenue NW
PO Box 1360 Stn Main
Edmonton, Alberta T5J 2N3
Canada
www.health.alberta.ca
Classification: Protected A
10. Provide a plan for the management of presumptive positives, and identification and notification
of close contacts in the workplace.
Section 3: Program reporting
11. Weekly reporting to Alberta Health (not AHS) on the screening program is required every
Wednesday. The weekly report will be submitted every Wednesday in a template provided by
Alberta Health that includes the number of tests performed, the number of presumptive
positives identified, and, where possible, the number of positives confirmed by PCR. No
individual information will be provided. Alberta Health may also request information on the
operations of the program for informing future work.
If you have additional comments on reporting, please provide them below:
Section 4: Privacy considerations
12. Provide a description of how individuals will be registered for screening and the process for
obtaining consent to participate.
13. Describe the privacy and security considerations the organization has undertaken to protect
confidentiality of screening results, including how tests will be conducted, results will be
delivered and records will be stored.
Please attach any supplemental or additional information to support your submission.
For more information or if you have any questions, please contact rapidtesting@gov.ab.ca.
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Organization Request for Rapid Testing Devices (Alberta Student Aid)

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Completed 8 June 2021

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