Pick Up Form
PLEASE READ BEFORE ORDERING.

The Chamber will notify you when your kits are ready for pick-up.

PLEASE DO NOT USE PERSONAL NAMES, USE ACTUAL BUSINESS NAME.

The workplace self screening program offered by the Greater Kitchener Waterloo and Cambridge Chambers of Commerce  is only available to businesses in the Region of Waterloo .

Please DO NOT visit the pick-up location until you have heard from us.

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Business Name *
Contact Name *
Email Address   *
City  (Business Location) *
Telephone Number *
Type of Business *
Picking up your order *
Number of Business Employees being Screened (For businesses only)  Please enter 0 if you are a daycare centre. *
Program Agreement/Commitment
TERMS AND CONDITIONS FOR PROVINCIAL ANTIGEN SCREENING PROGRAM

1. As part of the Ministry of Health and Health Canada, you are agreeing to participate in a “Supervised Self-Screening Program” for workplace employee screening. This program is under the sole responsibility and discretion of the Province of Ontario. The Province makes no guarantees about the availability or volumes of Screening Kits that may be available.

2. The Screening Kits provided by the Province to you are provided free of charge, on an “as-is” basis. Other than any warranty provided by the manufacturer, Ontario disclaims any and all representations, warranties and conditions, whether express, implied, written or oral, in relation to the Screening Kits, including fitness for use for any particular purpose.

3. The Province is bound by the Freedom of Information and Protection of Privacy Act (Ontario) and that any information provided to the Province in connection with the Program may be subject to disclosure in accordance with that Act.

4. You MUST:
     a. Ensure that the Screening Kits are:
           i. Used only for the purposes of the PASP (Provincial Antigen Screening Program).
           ii. Not resold or distributed to any other person.
     b. Report ALL data regarding results of the Screening Kits at www.ChamberCheck.ca, failure to do so will result in future  
     inability to participate in the program.
     c. In providing COVID-19 point-of-care antigen testing to individuals using the Screening Kits at your site, ensure compliance  
     with all applicable laws, provincial or federal directives, and provincial or federal guidance, including:
          i. Ministry of Health COVID-19 Guidance: Considerations for Rapid Antigen Screening.
          ii. Public Health Infection, Prevention and Control (IPAC) guidelines.
     d. Supply, at your own cost, the appropriate human resources and all equipment and supplies (other than the Screening Kits  
     themselves) required to perform the COVID-19 point-of-care antigen testing using the Screening Kits at your site.
     e. Ensure that the person Supervising the COVID-19 rapid antigen testing using the Screening Kits at your site, has  
     has viewed the video sent in confirmation email prior to administering tests. (suggestion is that the Health and Safety  
     designate be appointed as the Supervising Screener).

5. This agreement comes into effect upon execution and shall expire on March 31, 2022, unless terminated earlier in accordance with this section. Ontario may terminate this Agreement immediately upon written notice to you if you fail to comply with any term of this Agreement. For clarity, if the agreement is terminated, you shall no longer be participating in the PASP and shall not receive any further access to Screening Kits from Ontario.

6. This Agreement is made under and shall be construed according to the laws of the province of Ontario and the laws of Canada applicable therein.

Terms and Conditions *
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