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Personal Service Settings Special Event Application Form

The personal information on this special event application form is collected under the authority 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, K7M 1V5, 613-549-1232 or 1-800 -267-7875,ext. 1243. 

Completed form to be submitted to KFL&A Public Health ten (10) business days before the event.


Event information


Vendor information 


Service provider information 

Service(s) offered
 
Single-use equipment
 
Multi-use equipment
 
Single-use equipment to be used at event
 

Multi-use equipment must be:

  • covered with single-use, disposable covers as permitted, or
  • cleaned and disinfected or sterilized as appropriate at an approved premises, and used as single-use equipment during the event.    

 

Multi-use equipment to be used at event
 
Approved sharps container provided
 
Will you provide client record forms
 
Browse…

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Will you provide aftercare instructions
 
Browse…

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Hand hygiene stations
 
Hand hygiene station supplies
 

Cleaning and disinfecting 

By checking this box, I acknowledge I have read, understand, and agree that the information provided in this form is correct.
 
I would like to receive e-mail communication from KFL&A Public Health.
 


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Kingston, Frontenac and Lennox & Addington Public Health works together with our communities to promote and protect the public's health. Our commitment is to provide public health programs and services of the highest quality.

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I Want To:

Report

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Access

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Request

  • Condoms and safer sex supplies
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