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Special Events Notification Form

Vendor Application

O. Reg. 493/17: FOOD PREMISES under Health Protection and Promotion Act, R.S.O. 1990, c. H7. A person who gives notice of an intention to commence to operate a food premise to the medical officer of health under subsection 16 (2) of the Act shall include his or her name, contact information and the location of the food premise in the notice.

Application to be submitted to the Organizer so that documentation is provided to the Health Unit. 

A minimum of 14 days prior to the proposed event. 

 

This Notification Form is to notify the Haliburton, Kawartha, Pine Ridge District Health Unit of:
 

 

Special Event/Farmers Market Information:

Event/Market Layout:
 
Water Supply:
 
Sewage:
 
Garbage Disposal
 
Handwashing facilities/stations available:
 
Public Washrooms Available:
 
Animal Exhibits (Petting zoo, pony rides, poultry etc.)
 

 

Applicant Information:

Business Location:
 
Browse…

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

 

Food Items Served:

Add Food Remove Food

 

Operation Information:

Booth Location:
 
Potable Water Supply:
 
Certified Food Handler On-Site:
 
Cold Holding Equipment:
 
Hot Holding Equipment:
 
Cooking Equipment:
 
Sanitizing Agent (bleach, QUAT, etc.):
 
Sanitizer Test Strips:
 
Dishwashing:
 
Thermometers (probe and/ or indictor):
 
Booth Ceiling:
 
Single Use Items:
 

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:

Health Protection and Promotion Act, R.S.O. 1990, c. H.7 (ontario.ca)

O. Reg. 493/17: FOOD PREMISES (ontario.ca)

O. Reg. 319/08: SMALL DRINKING WATER SYSTEMS (ontario.ca)

Smoke-Free Ontario Act, 2017, S.O. 2017, c. 26, Sched. 3

Alcohol and Gaming Commission of Ontario | (agco.ca)

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

Useful Resources:

Food Premises Reference Document, 2019 (gov.on.ca)

Operational Approaches for Food Safety Guideline, 2019 (gov.on.ca)

Food Safety Matters – Farmers' Markets Ontario (farmersmarketsontario.com)

 



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