Essential Workers Pass online Registration form

Essential Workers Pass Online Registration Form
By completing this form you as the employer have read and understood the Essential Services and Restrictions Policy 2021 and the Public Health guidance for employers of essential workers who are COVID-19 cases or household contacts.

As an employer you agree to complete all required documentation, monitor your staff health and will report of any positive cases to Te Marae Ora through our online reporting system Positive Case Online Form

Please instruct your employee to contact TMO to organise collection of the supply of RAT tests for the 7 days of testing. Please ensure you and the staff member have capacity to provide the negative test results in picture form as proof of test result.
I have read and understood my obligations to adhere to the conditions of the Essential Services and Restrictions Policy 2021 and the Public Health guidance for employers of essential workers who are COVID-19 cases or household contacts.
Name of Organization*
Contact Phone Number*

Area CodePhone Number
Email*
example@example.com
Essential Worker Information
Name of Essential Worker*
Position of Essential Worker*
Date of Birth*

DayMonthYear
Date
Address/Village*
Reason for applying for the Essential Workers Pass:*
Should be Empty:

Essential Workers Pass Online Registration Form