Healthcare Workers Attestation

Tuberculosis Status

Evidence of Immunity

Credentials and Certifications

Vulnerable Sector Check

Covid-19 Testing

Personal information on this form is collected under the authority of JTCStuffing and will be collected, protected, used, retained in compliance with Ontario’s Freedom of Information and Privacy ACT R.S.O 1990, c. F.31. This information will be used by JTCStuffing and may be disclosed to clients of JTCStuffing’S at which independent contractors are working, for the sole purpose of administering that the standards are met as outlined as per The Occupational Health and Safety ACT R.S.O. 1990, c. O.1, s. 24 (2); 1994, c. 25, s. 83 (2). Health care workers have an obligation to protect patients and themselves from disease transmission that can occur with a health care practice setting. Immunization is an important tool in the prevention of infection and assists in safeguarding the health of independent contract workers. JTCStuffing and its client have mandated immunization and testing requirements for all independent contract workers. JTCStuffing and its clients have the right to refuse access to independent contract workers who do meet the immunization testing requirements. Failure to submit current, required documents within 30 days from the date of signature of the attestation, and request of JTCStuffing may result in the payment for billable hours withheld from independent contract workers, termination of current and/or future contract, and the suspension of their JTCStuffing account. Failure to notify JTCStuffing of any changes of health status regarding communicable diseases and or infections may result in the payment for billable hours withheld from independent contract workers, termination of current and/or future contract, and the suspension of their JTCStuffing account. Failure to submit and/or complete a Vulnerable Sector Check for the year of 2021, within 30 days of signature of the Attestation , and notice from JTCStuffing may result in the payment for billable hours withheld from independent contract workers, termination of current and/or future contract, and the suspension of their JTCStuffing account. I certify that by initialing and signing this document in the designated areas, I agree that the statements are true and correct to the best of my knowledge. I understand that any misrepresentation made by me in connection to this attestation will be sufficient cause for termination of my account with JTCStuffing.