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Disclosure of Personal Information Form


To prevent workers from developing occupational illnesses due to exposure to hazards such as asbestos, lead and silica, the OHS laws may require employers to implement medical monitoring programs in which workers are regularly examined to catch any health impacts as soon as possible. Because of the personal nature of the information gathered in such programs, you need workers’ consent to release that information, such as to their personal physicians.


Adapt this form, which is based on one from WorkSafeBC, for your workplace and medical monitoring program and the privacy laws in your jurisdiction. Use it to get consent from participating workers for the release of their personal information from the program. Be sure to retain the completed consent forms to document that you obtained such consent.