Interest List - Stand Up for Safe Workplaces

STAND UP FOR SAFE WORKPLACES INTEREST LIST
BC Centre for Women in the Trades, in partnership with the BCFED Health and Safety Centre, is excited to announce Stand Up for Safe Workplaces.

If you are interested in taking part in this training or want to learn more, please complete this form.

All forms will be handled in the strictest confidence.

Learn more about the program through our Stand Up for Safe Workplaces webpage. If you have any questions, please reach out to info@bccwitt.ca.
Name*

First NameLast Name
What are your pronouns?*
Please share your pronouns:
Email*
example@example.com
Phone Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If in British Columbia, please select your Economic Region:*
What is your gender?
Please tell us your gender:
Are you a member of an(y) equity priority group(s)? (BCCWITT is dedicated to removing barriers and obstacles, so we ask this question to make sure we can provide you with all the opportunities available to you; this is not to exclude anyone from any of our programs)

Racialized person2SLGBTQIA+Person with disabilitiesNewcomer or immigrantNone of the aboveOther
Do you identify as Indigenous?
Organization (if applicable)*
Workplace, union, training institution, community organization, etc.
Job Title/Occupation*
Trade or Designation
Level of skilled trade qualification (if applicable):
Do you have a union affiliation?

YesNo
What union and local? (Please spell out fully)
Do you consider yourself a leader or influential in your organization or trade?

YesNoUnsure
Do you have the support of your employer to participate in this program?

YesNoUnsure
Do you commit to facilitate workshops or share training materials following the completion of the program?

YesNoUnsure
Is your organization (workplace, union, training institution, community organization, etc.) interested in co-hosting a training in your community?

YesNoUnsure
Have you participated in any previous events or trainings hosted or facilitated by BCCWITT?

YesNo
In what BCCWITT event(s) or training(s) have you participated?
How did you hear about this opportunity?

Directly from BC Centre for Women in the TradesSocial mediaMy unionMy employerTraining institutionWord of mouthAt an conference or event boothOther
Is there anything else you'd like to share with us at this time?
Participant Collection of Personal Information Consent
All personal information on this form and other information related to your participation in the Stand Up for Safe Workplaces program (“Personal Information”) is collected pursuant to sections 26(c), 26(e), and 27(1)(a)(i) of the Freedom of Information and Protection of Privacy Act (the Act). This information will be used for administrative, evaluation, program development, and/or research purposes, including to determine your eligibility for participation in the program.

If you have any questions about the collection and use of this information, please contact info@bccwitt.ca.

Consent and Agreement

Effective as of the date set out below, I:
- Certify that all of the information that I have provided is accurate and complete;
- Consent to my Personal Information being used to contact me.
By signing this form I agree that BCCWITT can retain my personal information for the purposes of contacting me. I understand that BCCWITT will not release my personal information to any individual or organization except as outlined above, without my express consent in writing.*

Clear
Date of submission*

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STAND UP FOR SAFE WORKPLACES INTEREST LIST