General Visitor Risk Acknowledgement

A Risk Acknowledgement and Attestation form is the final step needed to complete the process to register as a General Visitor at St. Joseph’s Villa.

Step 1 of 6

  • Based on the MOLTC Direction, as of September 9, 2020 essential caregiver(s) are now permitted to enter a Long -Term Care Home. The following outlines the risks and responsibilities for myself who has been designated as an essential caregiver by a St. Joseph’s Villa resident, or his/her substitute decision maker. The safety of myself, and the residents and staff of St. Joseph’s Villa are based on a relationship of trust and expectations of all individuals involved to adhere to SJV policy, which is based on Directives provided by Public Health and the Ministry of Long-Term Care.

    By signing this attestation, I acknowledge that I am aware of the world-wide pandemic caused by the Coronavirus (COVID-19) and the evolving nature of the virus. I am aware of the danger of community spread and the risks posed to not only the residents health who I am visiting with but also to other residents and staff of St. Joseph’s Villa. I am also aware of the risk to my own health and agree to practice the outlined safety measures to prevent the spread of the COVID-19 Coronavirus.

    I agree to review and practice the Infection Prevention and Control measures and safety measures outlined on this information sheet. Specifically, I agree to:

    1. Use my best efforts to practice social distancing and hand hygiene practices in order to minimize the risk to the resident, myself and others.
    2. That I will wear a mask on Villa premises for the entire visit to reduce the risk to the resident(s). I also agree to wear other Personal Protective Equipment as required.
    3. That I agree to notify the Villa’s management staff immediately of a potential hazard, or of any information leading to a potential hazard to our operations or the residents who reside here.
  • General Visitor Information