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 



Your Feedback is Important to Us!

Take our Quick and Anonymous Survey.

We value your experiences with our services and invite you to share your feedback. Your insights help us improve and better serve our community.

Take Our Survey!

This website uses cookies to enhance usability and provide you with a more personal experience. By using this website, you agree to our use of cookies as explained in our Privacy Policy.