Notification of intent to open a personal service setting

In accordance with the Health Protection and Promotion Act (HPPA) and the Personal Service Setting (O. Reg 136/18), all new owners of a personal service setting intending to open in Durham Region must notify Durham Region Health Department prior to operating. Change in ownership of an existing personal service setting 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 personal service setting will not be approved for opening.

Instructions

Complete this online application form and submit to the Health Department.
Attach any additional information with your application (e.g., floor plans).
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

No

Owner's first name:

Owner's last name:

Owner phone number:

Operation information

If adding new services, indicate which services are new:

Liquor license?

Yes

No

Cleaning, disinfecting and infection control information

Disinfectants that will be used:

Location of reprocessing sink/area:

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, including location of hands sinks and reprocessing sinks, before and after care instructions for invasive services (if applicable):

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

IInformation is collected under the authority of the Health Protection and Promotion Act, R.S.O. 1990, cH.7., s.5 (as amended). This information is collected and used for the purpose of preventing, eliminating and/or decreasing the effects of a health hazard. Questions about this collection 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.