Notice of Intent to Operate, Intent to Renovate and/or Intent to Provide Additional Services Form: Personal Services Settings Search Submit Search Print this Page Home » Health Information » Beauty & Body Art » Information for Service Providers » Notice of Intent to Operate, Intent to Renovate and/or Intent to Provide Additional Services Form: Personal Services Settings All Personal Service Settings are required to notify the Health Unit of their intention to operate, any additional services that they may wish to perform and if they are renovating or constructing a personal service setting. 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ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Type of Business:(Required) Sole Proprietorship Partnership Corporation Name of Partner(s) if applicable: Add RemoveCorporation Identification if applicable: Add RemovePlease indicate if:(Required) New premises or relocation of existing premises (14 days notice prior to opening required) Reconstruction or renovation – services provided in process (notification required prior to commencing reconstruction or renovation Reconstruction or renovation – services discontinued (14 days notice prior to recommencing services required) Additional services provided (indicate new services in “list of services provided” below Proposed date of opening, reopening, commencement of renovations or addition of new services:(Required) MM slash DD slash YYYY Type(s) of services you intend to offer (if you are notifying about adding services, only indicate the new services below):(Required) Tattooing / permanent make up Body piercing and/or body modification Earlobe piercing Manicure, pedicure, and / or nail treatments Electrolysis Hairdressing / Barbering Micro-needling Laser hair removal Waxing Make-up Facials Lash extensions Other If "other" was checked please specify:Will you be renting or otherwise providing chairs, work stations or separate rooms to other persons (3rd party – i.e. subcontractor, tenant) who are operating independently of your business?(Required) Yes No Identity of 3rd Party Service provider(s) if applicable:Name, Business Name (if applicable) and Service(s) Provided Add RemoveProperty Site Plan Submission Already submitted I will submit a hard copy by mail or drop by the Brockville or Smiths Falls Health Unit office I will email an electronic copy to [email protected] (* include business name in the subject line) Existing premises, no changes to plan Note: Though not required by the regulation, the health unit strongly recommends that new businesses submit plans for review in the early stages of planning so that necessary physical changes can be addressed during the renovation/construction phase rather than at the last minute prior to opening. If this notification is for a new or relocated business, please complete the following (mandatory):1. Have you notified your municipality about opening a business?(Required) Yes No 1a. Have they confirmed you meet zoning, property standards, fire prevention, etc. requirements, as applicable? Yes No Pending 2. Are you operating a home-based business?(Required) Yes No 2a. Is the room where services are offered completely separate from the rest of the dwelling?(Required) Yes No The setting must not be a room or part of a room that is used as a dwelling, including for dining, sleeping or preparing, selling, handling, eating or storing food. 2b. If pets are in the home, is there a means of keeping them out of the personal service setting?(Required) Yes No 3. Is your business on a septic system?(Required) Yes No Is the septic system sized/approved for commercial use?(Required) Yes No I don't know Septic system inspections are carried out by your municipality / township or contracted out to the Conservation Authority (CA). Contact your municipality or CA to determine if a septic inspection is required.4. Is there an adequate source of hot and cold running potable water servicing the building?(Required) Yes No If you are on a well, send in a sample for testing and provide a copy of your test results.5. Are the floors, walls, ceilings and furniture made of smooth, easily cleanable materials and in good repair?(Required) Yes No 6. Is there a sink available for hand washing conveniently located to the service area with hot and cold running water*?(Required) Yes No *This may be a washroom sink where the washroom is part of the Personal Services Setting7. Is there a separate sink available for cleaning / disinfecting of reusable equipment, that is NOT the hand washing or kitchen (if home based) sink*?(Required) Yes No *If offering hair services / barbering only, you may be eligible for an exemption. 8. Do you have manufacturer instructions for your equipment, if applicable?(Required) Yes No N/A 9. Do you have appropriate disinfectants and are you familiar with how to use them properly?(Required) Yes No Ensure you read and follow the manufacturer’s instructions, including if test strips are required, e.g., multi day use products require appropriate test strips and daily logs.Name of Disinfectant & Drug Identification Number (D.I.N.) *(Required) Add Remove* With the exception of chlorine bleach, disinfectants in Canada must have a Drug Identification Number (D.I.N.) 10. Will you be providing invasive services (e.g. tattooing, piercing, electrolysis etc)?(Required) Yes No 10a. How will you ensure equipment, instruments, jewelry etc. used for invasive procedures are sterile?(Required) Purchased sterile and are single use and disposed of after use Sterilized on-site. Provide name/model number of sterilizer(s) below. Sterilized off-site or using 3rd party service provider. Provide name/location where items will be sterilized below. Note: Every operator of a personal service setting shall ensure that sterilizers used at the setting are suitable for sterilizing the equipment used at the setting and meet the standards established by Health Canada and the Canadian Standards Association.Name/model number of sterilizerName/location where items will be sterilized below.10b. Do you have appropriate client record forms, after care instructions and approved sharps container(s)?(Required) Yes No N/A 10c.. Do you have an approved sharps container?(Required) Yes No N/A 11. Have you attended training around the services you are providing? Please list applicable courses, certificates, diploma’s degrees, etc.(Required) Yes No If yes, please list applicable courses, certificates, diplomas, degrees etc.: Add RemoveAdditional information/Comments:Please be aware this is not an exhaustive list of requirements. A public health inspector will provide further guidance to ensure you are able to meet requirements for Ontario Regulation 136/18 Personal Service Settings. Please review this Regulation here: https://www.ontario.ca/laws/regulation/180136.Personal Health and Information Protection Act (PHIPA)Personal information on this form is collected under the authority of the Health Protection and Promotion Act, S.O. 1990, H.7, O.Reg. 136/18 and will be used for the provision of recording health information. Questions concerning the collection of this information should be directed to the Director of Community Health Protection Department of the Leeds, Grenville and Lanark District Health Unit, 458 Laurier Boulevard, Brockville, Ontario K6V 7A3. Telephone: 613-345-5685.CAPTCHA