• Template Consent & Processing Form

    **PLEASE NOTE** YOU ONLY NEED TO FILL OUT THIS FORM ONCE. NOT EVERY DAY YOU ARRIVE ON SET.
  • I give my consent to have myself or child/dependent to be tested for COVID-19. I understand and give my consent for Polymerase Chain Reaction (also known as PCR) test, Rapid Antigen, and/or Molecular testing to be performed via Bilateral Anterior Nasal, Deep Nasal, Oropharyngeal, and/or Nasopharyngeal collection methods by a trained professional performing within the scope of their practice using instruments approved by Health Canada. I understand and accept any risks associated with the testing procedure, such as minor irritation and/or bleeding, possible transfer of infection from the testing nurse to me or my dependent, or any other unforeseen conditions or complications. I will also disclose any nose, face or sinus injuries, surgeries or conditions to the individual performing the test prior to each collection. I authorize Pulsar UV Inc. to collect and confidentially store my personal information for repeat testing and communication purposes, and laboratory results for ten years as per standard healthcare practice. I also authorize Pulsar UV Inc. and the laboratory(s) they use to release my/my dependent’s test results, and share said results (if applicable) with the employer/production providing testing, the production’s/workplace’s appointed COVID-19 Health and Safety representative(s), Public Health, my department head/managing body(s), and within Pulsar UV Inc. via email, phone, text, and/or fax. I accept any risks associated with the transfer of my/my dependent’s health information through communication (ie. a possible leak, hack, breach in security, etc.).


    I understand that I will be notified of my/my dependent’s test result via the email address listed above. If I receive a positive result, an attempted phone call and/or text may be used as first means of communication for prompt action. Additionally, if I receive a positive result (if applicable), my employer, manager, supervisor and/or production, and/or relevant department heads and/or appointed COVID-19 department representatives will be notified, Public Health (by law) will be notified, and I will be required to follow all current Public Health guidelines for the area. I may request to receive my official lab results at any time during and two weeks following my testing date or production’s testing period (whichever is later) via email at info@pulsaruv.com.


    I understand that with any form of current testing, there is a chance of a false negative or false positive result and I will continue to adhere to all COVID-19 safety protocols set out by government/local authorities, my production and/ or workplace, and render Pulsar UV Inc. and any associated laboratories they may use, harmless of any damage or harm should a false result be reported. This consent will extend and cover all future testing dates with Pulsar UV Inc. with my current employer/production. I understand I may withdraw my consent at anytime in formal writing to info@pulsaruv.com


    For other helpful links and Public Health guidance, please go to www.pulsaruv.com/publichealthlinks

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