Required fields are marked with asterisks (*)

Notification of intent to open a food premises

In accordance with the Health Protection and Promotion Act (HPPA) and the Food Premises Regulation (O. Reg 493/17), all new owners of a food premises intending to open in Durham Region must notify Durham Region Health Department prior to operating. Change in ownership of an existing food premises also requires notification prior to operation. If this applies to you, please complete this form. A public health inspector will be in contact to review the application, floor plans and to arrange a pre-operational inspection with you.

Note: Please ensure that all regulatory requirements have been met prior to inspection; otherwise the food premise will not be approved for opening.

Instructions

Complete this online application form and submit to the Health Department OR download and complete the PDF application if you prefer to mail or fax your application to the Health Department.
Attach any additional information with your application (e.g., floor plans, food safety plans, menu items).
A public health inspector will be in contact with you to review your submission and schedule an inspection.

By submitting this form you acknowledge and understand:

You will be contacted by email or phone for processing your application and to arrange a pre-operational inspection.
How the information provided in this form will be collected, used, and disclosed by the Health Department.
Durham Region Health Department (DRHD) takes steps to protect the privacy and security of emails. Emails are not always secure and DRHD cannot guarantee the security of any messages sent or received. Personal information you provide by email will only be used to respond to your message and/or to provide you with the requested information.
You may withdraw your consent to the use of email at any time by contacting us.
Not to use email for emergency or urgent health care matters.

General premises information

Premises name:

Premises street address:

City/Town:

Postal code:

Premises phone number:

Premises fax number:

Email address:

Please indicate the status of the business:

Existing business

New business

Date opening

Date closing

Ownership information

Is the owner a numbered company?

Yes

Owner's first name:

Owner's last name:

Owner phone number:

Operation information

Are you canning or boiling?

Yes

Are you preparing any manufactured meats? (e.g. curing, smoking, dehydration, fermenting)

Yes

Will a certified food handler be present during every hour of operation?

Yes

Indoor seating capacity:

Do you have an outdoor patio?

Yes

Liquor license?

Yes

Will tobacco products be sold?

Yes

Dishwashing information

What kind of utensils and containers are you providing customers when serving your food? Select all that apply.

Re-usable

Disposable

What type of dishwashing equipment will be used? Select all that apply.

Industrial mechanical high-temperature rinse dishwasher

Industrial mechanical chemical sanitizer dishwasher

Glass washer

3-Compartment sink

2-Compartment sink

Type of chemical sanitizer used for dishwashing:

Type of chemical sanitizer used for food contact surfaces:

Note: Must be approved sanitizer as per the Food Premise Regulation O. Reg 493/17.

Note: Please outline these hand wash basins on the floor plan you upload with this form.

Water and sewage information

Water supply

Municipal

Private

Sewage disposal

Municipal

Private

Uploads and attachments

Please note that our reporting system is unable to process attachment(s) larger than 14MB. If the total size of all uploads is greater than 14MB, you will need to reduce the file size prior to uploading.

Please upload your relevant floor plans, menu items, and food safety plans

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

Information is collected and used under the authority of the Health Protection and Promotion Act, R.S.O. 1990, cH.7., s.5 and its Regulations. This information is collected and used for the purposes of processing your application for the intent to open a food premise or notification of a change in ownership of a food premise; for preventing, eliminating and/or decreasing the effects of a health hazard; and, for planning, providing, and evaluating services provided by Health Department staff for promoting health and protection. Questions about this collection and use of information should be addressed to Durham Region Health Department, Manager, Health Information, Privacy and Security at 605 Rossland Rd E., P.O. Box 730, Whitby, ON L1N 0B2, (905) 668-7711.

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