Notice of Intent to Operate a Food Premise

Section 16(2) of Ontario Health Protection and Promotion Act, R.S.O. 1990, c. H 7 requires every person who intends to operate a food premise shall give notice of their intention to the health unit in which the food premise will be located.

According to the Food Premises Reference Document, 2019 a food premise is defined as a place where food or milk is manufactured, processed, prepared, stored, handled, displayed, distributed, transported, sold or offered for sale, but does not include a room actually used as a dwelling in a private residence.

This application, together with the plans and drawings, must be submitted to Huron Perth Public Health at least 14 days prior to commencing operation.

Food Premise Information

Business Name:

Date of Opening:

911 or Street Number:

Street:

City/Town:

Postal Code:

If other, please define:

If seasonal, months of operation:

Owner's Information

Owner's Name:

Owner's Email Address:

Owner's 911 or Street Number:

Owner's Street Name:

Owner's City/Town:

Owner's Postal Code:

Owner's day phone:

Owner's evening phone:

Owner's cell phone:

Owner's fax number:

Operator's Information

Is the owner also the primary operator?

Yes

Only fill out the section below if the owner is NOT the primary operator.

Operator's Name:

Operator's Email Address:

Operator's 911 or Street Number:

Operator's Street Name:

Operator's City/Town:

Operator's Postal Code:

Operator's day phone:

Operator's evening phone:

Operator's cell phone:

Operator's fax number:

If a Registered Corporation:

Corporation name or number:

Principal Officer's Name:

Corporation's 911 or Street Number:

Corporation's Street:

Corporation's City/Town:

Corporation's Postal Code:

Corporation's phone number:

Corporation's Email Address:

Water supply:

Municipal

Private well

Communal well

Waste disposal

Municipal

Private

Ontario Regulation 493/17: Food Premises requires every food service premise ensure that there is at least one food handler or supervisor on the premise who has completed food handler training whenever the premise is open.

Number of certified food handlers:

By checking this box, I acknowledge I have read, understand, and agree that the information provided in this form is correct.

Yes

The personal information on this form is collected under the authority of The Health Protection and Promotion Act, R.S.O. 1990, c. H. 7. It will be used for ownership identification and enforcement of the Act and the applicable Regulations under the Act.

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Notice of Intent to Operate a Food Premise

Food Premise Information

Owner's Information

Operator's Information

If a Registered Corporation: