Special Events Notification Form

Please complete and submit this form at least 2 weeks prior to the event date.

Retain a copy of this form for your records; you will NOT be mailed/faxed a copy. If there are concerns, the public health inspector will call the person(s) responsible to clarify.

Note:

  1. Every person who intends to sell food to the public must notify the Health Unit in accordance with Section 16(2) of the HPPA.
  2. Contact must be made with the Tobacco Enforcement Officer (TEO) to ensure compliance with the Smoke Free Ontario Act. Contact the TEO at smokefree@elginhealth.on.ca or 519-631-9900 Ext. 1325 before submitting this form.

Event Information

Food Items to be served (please list)Food supplier or store/business where purchasedAddressPhone

The Personal Information on this Special Events Notification Form is collected under the authority of the Health Protection and Promotion Act and applicable privacy legislation. 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:
ESTPH Privacy Officer
1230 Talbot Street, St. Thomas, ON N5P 1G9
Phone: (519) 631-9900; Fax: (519) 631-3745
E-mail: estph@elginhealth.on.ca