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Application to open or reopen a public spa.

This is to notify the Public Health Inspector of my intention to open or re-open a public spa in accordance with Regulation 565 Public Pools, section 5, under the Health Protection and Promotion Act. As the owner, I understand I will also be considered the operator, unless I designate another individual as my operator at this time.

The personal information on this form is being collected under the authourity of the Health Protection and Promotion Act, and will be used for the administration of public health programs. Any questions about the collection of this information should be directed to the Manager of Environmental Health, KFL&A Public Health, 221 Portsmouth Avenue, Kingston, Ontario, 613-549-1232 or 1-800-267-7875.

Name of facility

Address

Ward or Township (e.g., Napanee, Kingston, North Frontenac etc.)

Owner's name

Phone number (999-999-9999)

Owner's address

E-mail address (to receive your submission receipt)

I (insert name)

I am the owner or owner's agent of the above spa

owner

owner's agent

I am providing the following information

1) The building number issued for the construction or alteration of the spa (if applicable)

2) Have the preparations necessary to operate the spa in accordance with this regulation have been completed

Yes

3) The date the spa is intended to be opened or reopened for use (notification must be at least 14 days in advance)

4) Operator's name

Operator's phone number (999-999-9999)

Operator's address

Every operator shall be trained in public spa operation and maintenance, filtration systems, water chemisty and all relevant safety and emergeny procedures. Please provide a list of the operator's qualifications and training.

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

Yes