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If you require assistance completing this form or uploading a file, please call the Durham Health Connection Line at 905-668-2020 or 1-800-841-2729.
By submitting this form, you acknowledge and understand:
Are you looking to submit an application for a food business or special event, personal service setting, public pool, spa, class c recreational water facility, or seasonal housing for international agricultural workers? We have additional online application forms dedicated to these programs that can be submitted directly to the Health Department.
Find additional application forms on our Your Business and Public Health page
You can upload a maximum of 3 files per form submission. Our application system is unable to process/accept files larger than 4MB. If any of the attachments you are attempting to send us are greater than 4MB, you will need to reduce the file size prior to uploading them through our online form.
If you need to provide us with more than the 3 file maximum, you will have an opportunity to provide these after you have submitted this form and a public health inspector contacts you to discuss your application.
Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png
Information on this form 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. The information is collected and used for processing and following up with your application for the intent to open a personal services setting facility, notification of change in services or notification of a change in ownership of a personal services setting facility; 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. Information may be disclosed to external institutions and agencies for investigations, inspections that lead or could lead to proceedings, legal and/or regulatory requirements or as required by law. 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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