DetectNWT Rapid Antigen Test Request

If your organization has been approved for participation in DetectNWT, please submit this request

Using this form for new tests and keeping your reporting up to date helps your request proceed quickly. Thank you for your participation.

Organization Name

This Organization has applied and been approved for DetectNWT

Location(s), including address(es) where the organization operates and will deploy rapid antigen tests

City/Town

Full name of key contact

Telephone number

Please provide a direct line or extension if necessary

Phone

Email address

Total # Tested

Requesting Tests Bi-weekly or Monthly?

Frequency of Testing

# of Tests Requested

Please indicate the number of tests you will require for the duration of time you have requested (bi-weekly/monthly).

Please review DetectNWT's Program Terms and Conditions by clicking this link

https://www.nthssa.ca/en/detectnwt-program-terms-and-conditions

Checking this box confirms that the Organization requesting Covid-19 Rapid Antigen Tests has been approved for participation, and has read and agrees to comply with the Program Terms and Conditions

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