Staff Pre-Departure Notification Form

Your website

Traveler’s name

Traveler’s email:

Destinations (city/province/state, country):

Purpose of travel:

Proposed travel dates:

Please confirm the following:

I have checked the Government of Canada travel advisory level, and the country is either level 1 or 2. The University will not approve university-related travel for staff members for level 3 or 4 destinations as per the interim university-related travel policy.

I confirm

Please indicate the country level:

Level 1 Level 2

I will register with the SFU Travel Registry

I confirm

I have appropriate travel and medical insurance based on my own needs and understand that Simon Fraser University will not be providing nor arranging for any personal insurance coverage and that I will be responsible for all medical costs and deductibles not covered by my personal insurance.

Pacific Blue Cross travel insurance information
*If you are not covered through Pacific Blue Cross please check with your insurance provider.

I confirm

I will review the health, safety, and security services provided by International SOS. SFU membership number 27ACAS593560.

I confirm

Department chair, director or designate Name

Department chair, director or designate Email