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Special Events – Food Vendor Application

Under Section 16(2) of the Health Protection and Promotion Act, every person who intends to commence to operate a food premises shall give notice of the person’s intention to the Medical Officer of Health of the Health Unit in which the Food Premises will be located.

Please submit a completed form to the Health Unit within 10 working days prior to the event to allow adequate time for processing. Failure to be in compliance with the Food Premises Regulation may result in closure of your premises.

  • Date Format: MM slash DD slash YYYY
  • Contact Person * Required
  • Contact Address * Required
  • Menu Items

  • Food Facility

  • Type of Food Facility * Required
  • Potable Water Source * Required
  • Sinks Provided with hot and cold running water under pressure * Required
  • Waste Water Disposal * Required
  • Cold Storage * Required
  • Garbage Receptacles Provided * Required
  • Smoke-Free Ontario Act 2017 * Required
    Owners and operators have a responsibility to ensure compliance with the Smoke-Free Ontario Act 2017. (See sections 14 and 15).
  • I have received and read the Special Events information package provided and I accept responsibility for ensuring that the information that I have provided on this form is correct. * Required
  • Health Unit Internal Use Only

  • Personal Information

    Personal information on this form is collected under the authority of the Health Protection and Promotion Act, R.S.O. 1990, c. H.7 as amended under Section 16 (2) and will be used for the administration and enforcement of the Food Premises Regulation. Questions concerning collection of this information should be directed to the Privacy Officer of the Leeds, Grenville & Lanark District Health Unit at 458 Laurier Blvd, Brockville, ON, K6V 7A3 or 1-800-660-5853.