Form Builder

Required fields are marked with asterisks (*)

Smoke-Free Ontario Act School Incident Report Form

The Smoke-Free Ontario Act, 2017, states that smoking and vaping is not allowed in public and private schools. This includes school grounds, and public areas within 20 metres of any point on the perimiter of school property. This Act is in effect at all times and applies to staff, students, parents, and visitors on school property including parking lots, inside vehicles, on sports fields and public areas within 20 metres from the perimeter of the school property.

Smoking refers to the smoking or holding of lighted tobacco or cannabis (includes medical).

Vaping refers to inhaling or exhaling vapour from an electronic cigarette/vape or holding an activated electronic cigarette/vape, whether or not the vapour contains nicotine or cannabis.

Please use this form to submit a violation of the Smoke-Free Ontario Act, 2017 that occurs on school property within Huron and Perth counties. Your report will be directed to a member of our enforcement team, and will be followed up by an enforcement officer.

Were parent(s)/guardian(s) notified:
Method of parent/guardian notification:
Are you aware if this student has had any previous Smoke-Free Ontario Act violations?
Has any previous action been taken against this student with regards to Smoke-Free Ontario Act violations?
If so, what action was taken that you are aware of? (Check all that apply)

Offence Information

Product involved

Please select the product(s) involved and how being used (select all that apply):

Key Witness

Witness Report

Do you know the student personally?
Could you see smoke or vapour from the product?
Are you certain that what you saw was smoke or vapour, not breath?
Could you smell smoke or vapour?
Could you smell other odours?

Other Witnesses (if applicable)

Additional comments

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

If you require a copy of this information for your records, please print this page.


Personal information on this form is collected under the authority of the Health Protection and Promotion Act, Smoke-Free Ontario Act, 2017, and the Education Act, and is for administrative use as determined by the Avon Maitland District School Board's Policy 356: Substance Abuse by Students under the Board's Jurisdiction, or the Huron Perth Catholic District School Board's Policy 3E:9 - Smoking and Vaping on Property under the Board's Jurisdiction.

Questions about the collection of personal information should be directed to the school prinicpal, the Director of Population Health of Huron Perth Public Health (1-888-221-2133), the Tobacco Program Public Health Manager of Huron Perth Public Health (1-888-221-2133) or the Superintendent of the respective school board.