Evacuated Health Care Workers

The purpose of this form is to gather information from evacuated health care workers who are interested in available work options.

Please note alternative work is not guaranteed however you may be contacted when alternative work options are available.

For more information, please review this FAQ document.

Evacuated Health Care Workers

"*" indicates required fields

Company

This field is for validation purposes and should be left unchanged.

Name*

Preferred name

Employee ID*

Phone*

Personal email*

Work email*

Department*

Classification*

Job Title*

Current Regional Health Authority (RHA)*

Union Group*

Current FTE*

Current Shift Description*

Current Manager / Supervisor

EVACUATION INFORMATION

RHA of Evacuated Location

City / Town evacuated to?*

Province evacuated to?*

Communities available to work at?*

Date Available to commence work in alternate community?*

Alternate work options*

Please note that default time keeping is an unpaid leave. If you are looking to utilize vacation or other banks, please contact your manager for review & approval and/or complete the appropriate forms to request time off.

Additional comments