Pre Authorization Form


    This is an Visitor Pre-Authorization Request form. A new form is needed for every class session. Please refill this form for every class upon your arrival in the morning of the class date and submit. It will be automatically emailed to us. This is your template.

    Until further notice, all approved visitors are required to complete a COVID-19 screening questionnaire, before entering any class as required by the government of Ontario and Ontario health as a part of new requirement after entering phase 3. Visitors will need to enter their unique Visitor Pre-Authorization Control Code (Cell Number) below to submit the screening.

    Request Summary:


    Humber College
    110 Carrier Dr. Etobicoke, Ontario Host:

    Sam Mallak

    Start Date:

    End Date:


    Number of Visitors:

    1 Coordinator:

    Sam Mallak Coordinator Phone #:

    (416) 841-1399

    Visitor or Visitor Coordinator:

    Sam Mallak

    Visitor Coordinator Phone #:

    (416) 841-1399

    Visit Type:


    Business Case:

    Training Electrical Apprentices on the 309A electrical exam.

    Visitors Details

    *Note - if you answer “Yes” to any question(s) do not report to class and call (416) 841-1399 to report your absence if applicable.

    1. Have you experienced COVID-19 symptoms such as a cough or shortness of breath, or two or more of the following: fever, sore throat, diarrhea, or a loss of taste or smell in the past
    14 days?


    2. When you took your temperature within the past 2 hours, was your temperature 100.4F/38C or greater?


    3. Have you traveled internationally, including the U.S. within the past 14 days?


    4. Have you been in close contact (within 6 feet for 15 minutes at a time) with a person who has a confirmed or suspected case of COVID-19 within the past 14 days?


    5. Are you awaiting test results or awaiting a scheduled test (due to symptoms, exposure or association), or are you required to be in self-isolation or quarantine; based on a health care providers instructions or current provincial health guidelines?