Notice of Intent to Operate a Food Premise

(if different from mailing address)

IF A REGISTERED CORPORATION:

TYPE OF FOOD PREMISES:

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Please Note:

  1. The Health Protection and Promotion Act requires every person who intends to operate a food premise to give notice of this intention to the health unit through which the food premise will be located.

  2.  As of May 31, 2006, the Smoke-Free Ontario Act will require all public places and workplaces in the province to be 100% smoke-free.
    ** Contact MUST be made with Southwestern Public Health’s Tobacco Enforcement Officer (TEO) in order to ensure compliance with the Smoke Free Ontario Act. Contact the TEO at 1-800-922-0096 before submitting this form.

The Personal Information on this Notice Of Intent To Operate a Food Premise Form is collected under the authority of the Health Protection and Promotion Act, R.S.O. 1990, Ch. H.7., and applicable privacy legislation. It will be used for ownership identification and enforcement of regulations made under this Act. This information will be used for delivery of public health programs and services and may be used for evaluation or statistical/research purposes. Any questions about the collection of this information should be directed to:
Southwestern Public Health, Privacy Officer
1230 Talbot Street, St. Thomas, ON N5P 1G9
Phone: 1-800-922-0096; Fax: (519) 631-3745

I hereby certify that, to the best of my knowledge, the provided information is true and accurate.