Intention to Operate a Food Premises Search Submit Search Print this Page Home » Health Information » Food Safety » Operators of Food Businesses » Intention to Operate a Food Premises Printable Notice of Intention to Operate a Food Premises Form PDF Online Notice of Intention to Operate a Food Premises Form *mandatory fields Business Name * Required Business Address * Required Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Business Phone Number * RequiredBusiness Email * Required Business Owner Name * Required Corporate Name/Number * Required Mailing Street Address * Required Mailing Town/City * Required Mailing Postal Code * Required Type of Business Sole Proprietorship Partnership Corporation List of Owners or Directors of Corporation (if applicable) Please indicate if: * Required New Premises Alteration Re-opening Temporary Permanent Date of Opening * Required MM slash DD slash YYYY Is the business a home-based business? * RequiredIf yes, please ensure you check with the municipality regarding zoning. Yes No Are you on a septic system? * RequiredIf you answer “yes” to a home-based business on a septic, a septic inspection will be required to ensure your residential septic system is capable of supporting any additional use. Yes No Water Source * Required Total of Indoor and Outdoor Seating * Required Number of Certified Food Handlers * Required Proposed Number of Food Handlers Proposed Number of Managers * Required Months of Operation if not year round ( _______ to _______ ) * Required Sewage Disposal Type * Required Licensed by L.L.B.O. * Required Yes No Hours Open ( ________ to ________ ) * Required Outdoor Patio * Required Yes No Property Site Plan Submission * Required 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 Building and Equipment Plan Submission * Required 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 Menu Submission * Required 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 Brief Description of Your Proposed Operation * RequiredPersonal Health InformationPersonal information on this form is collected under the authority of the Health Protection and Promotion Act S.O. 1983, C10, and will be used for the provision of recording information for the Community Health Protection Department. Questions concerning the collection of this information should be directed to the Director of Community Health Protection Department of the Health Unit, 458 Laurier Boulevard, Brockville, Ontario K6V 7A3 (613) 345-5685.CAPTCHA