Important Update: Health Units Merging

Please be advised that as of January 1, 2025, Haliburton, Kawartha, Pine Ridge District Health Unit and Peterborough Public Health will merge to form the Haliburton Kawartha Northumberland Peterborough Health Unit. This is our legal name only.
We are currently undergoing a process to develop a new brand identity that will also include a new name. This will take us several months to finalize. During this time, you will continue to see logos and other marketing material with the HKPR District Health Unit branding. You may also see some documents using our legal name Haliburton Kawartha Northumberland Peterborough Health Unit.
Partners and members of the public should continue to engage with their local public health offices as usual until otherwise directed. All communication channels including emails, faxes and office locations remain the same until further notice.  
Required fields are marked with asterisks (*)

Personal Service Setting Special Event Form

Personal Services Vendor Information

The personal information on this special event application form is collected under the authority of the Health Protection and Promotion Act and will be used for the administration of Public Health programs.  Completed form to be submitted to HKPR District Health Unit ten (10) business days before the event.

 

 

Organizer Information:

 

 

Vendor Information:

 

Indoor or Outdoor:
 
Previously inspected by a Health Unit:
 
Add Vendor Remove Vendor

 

Services Offered and Equipment (check all that apply):

 

Aesthetics:
 
Medical Aesthetics:
 
Body Modification:
 
Other:
 
Will you be bringing equipment that requires sterilization?
 

Handwashing:

 

Is there a separate handwashing basin with hot and cold or warm running water provided in the service area? NOTE: Alcohol based hand sanitizer is required on-site.
 

Reprocessing:

 

Where will reusable instruments be cleaned and disinfected:
 

Water Source:

 

Type of Water Source:
 

 

 

 

Please contact the health unit to discuss the legal requirements, review plans and/or conduct a pre-operational assessment prior to the proposed event.

Any personal and personal health information that you may provide on this form is collected under the authority of relevant legislation including: the Health Protection and Promotion Act, as amended, the Regulated Health Professions Act, the Immunization of School Pupils Act, and the Personal Health Information Protection Act. This information will be used for assessment, management, treatment, and reporting purposes. Your information may be shared within the Health Unit as required by legislation. For information about the collection, use and disclosure of your information, please refer to the Health Unit website at www.hkpr.on.ca or contact the Medical Officer of Health, 200 Rose Glen Road, Port Hope, Ontario, L1A 3V6 or 1-866-888-4577.

Legislation that may apply to your premise may include:

O.Reg 136/18 PERSONAL SERVICE SETTING

 Local Municipality for Building/structural items and by-laws (garbage areas, zoning, business license, etc)

Useful Resources:

Guide to Infection Prevention and Control 

Personal Service Setting Guidelines 



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