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Education Request Form

Please fill out the request form below to help us plan the education event. We will provide an estimated budget once we look over your details.

You can also download a printed version of the Education Request Form here. If you fill in the form this way, just fax it to or scan and email it back to info@workershealthcentre.ca.

  • MM slash DD slash YYYY
    List your first choice for the date of the event.
  • MM slash DD slash YYYY
    List an alternate date for the date of the event.
  • MM slash DD slash YYYY
    List an second alternate date for the date of the event.
  • Examples such as Hazard Identification and Control, Health and Safety Legislation, Ergonomics etc. Be as specific as you can about what you want and why. It helps us to plan. We will discuss this on the phone or in person.
  • Please describe the event or activity.
  • Please describe start times, break times / lunch, end times.
  • Describe its rough size, windows, etc.
  • Please describe the overall plan.
  • If not sure, you can just give us a reasonable estimate. This allows us to prepare materials and to prepare appropriate classroom exercises.
  • Please just list them here.
  • MM slash DD slash YYYY
    You may be asked to provide a list of the names of participants 2 weeks prior to the scheduled date. This will be used as a ʻcut-offʼ date to prevent last minute cancellations.