UPDATED: July 2022
Below, please find the information and documents that the sponsor and observer need to complete. The Memo and Letter of Agreement are in word format for ease of completion. Please Note Observerships should only be for 1 – 4 weeks.
As well, here is the information on the immunizations:
Alberta Health Services is committed to supporting the health and safety of AHS representatives and patients by protecting them from contracting vaccine preventable communicable diseases. The CDA form will assist AHS in fulfilling that commitment.
Compliance with this document is required by all Alberta Health Services employees, members of the medical and midwifery staffs, Students, Volunteers, and other persons acting on behalf of Alberta Health Services (including contracted service providers as necessary).
Please communicate to the observer that we, the Site Medical Staff Office will not be able to proceed with the request for Observership until he/she has provided proof of his/her immunization and immunological status to communicable diseases including, but not limited to:
Measles
Mumps
Rubella
Chicken Pox (Varicella)
Whooping Cough (Pertussis)
Hepatitis B
Influenza
Tetanus Diphtheria
All individuals that don’t have an immunization record must complete a communicable diseases assessment (attached form or by following the link below) and set up a meeting with an Occupational Health Nurse as per information on AHS Insite (http://insite.albertahealthservices.ca/8541.asp).
Please use the below check list to ensure that you have completed all the documentation as required. Once the completed documents have been returned to me, I will send off for final approval.
CHECK LIST – Observership
Kindly note the following information must accompany the application in order to expedite approval - preference is for requests to be submitted at least 3 weeks prior to the start date. The observership cannot commence until all approvals have been received.
Observership Request Form (copy attached)
Medical Staff Observer ’s recent Criminal Record Check (not required if less than 5 days) MUST BE WITHIN 90 DAYS OF START DATE
Proof of completion of AHS Privacy and Confidentiality Training
Copies of all Immunization Records - must include all 2 Covid Vaccines
What are the dates of the observership?
What department and where will this observsership take place?
The Zone Clinical Department Head for where this observership will take place, must sign off on the form.
Current CV
Immunization Requirements
Job shadowers will have the appropriate immunization to protect against the risk of communicable disease transmission. Immunization/proof of immunity against rubella is mandatory, in accordance with applicable legislation. Immunization is strongly recommended against hepatitis B, measles, mumps, varicella (chickenpox), seasonal influenza, polio, pertussis (whooping cough), tetanus, and diphtheria. Proof of other immunization/immunity may be required, subject to unit-specific requirements.
Proof of required immunization/immunity will be provided to the applicable manager (or designate) prior to the commencement of an observational experience. Requests for observational experiences may be declined when proof of required immunization/immunity is not provided.
Thank you,
Michelle Andrews
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Medical Affairs – Edmonton Zone
Medical Leadership Administrative Assistant
Administrative Assistant – Dr. Derek (Rex) Townsend
Facility Medical Director, University of Alberta Hospital,
Mazankowski Alberta Heart Institute
and Kaye Edmonton Clinic
Administrative Assistant – Dr. Chester Ho
Zone Clinical Department Head, Neurology
1F1.08 WMC, 8440 – 112 Street
Edmonton, AB
T6G 2B7
tel 780-407-2798 fax 780-407-7868