Temporary Personal Service Setting Notification Form

Each personal service setting operator must complete and submit a Temporary Personal Service Setting Notification Form to the Eastern Ontario Health Unit (EOHU) at least 30 days before the event. We cannot guarantee that notification forms received less than 30 days before the event will be processed on time. Only personal service setting operators that have been approved by the EOHU can operate at an event.

Required fields are marked with an asterisk (*).

Business Information
Owner/Operator Information
Alternate Contact
Event Information
Is this your first time providing personal services at a special event?*
Will you be attending more than one event?*
Vendor Setup*:
Types of services I will be offering at the event*:
Will services be provided to the public?*
Instruments and Sterilization

Reprocessing / sterilization of instruments is not permitted on-site.

It is recommended to use instruments that are single-use disposable and to bring multiple instrument sets for service on-site.

I confirm that I will only be using single-use disposable instruments at this event.*
I confirm that I will transport clean and sterilized equipment in labelled containers. *
I confirm that I will have instruments requiring sterilization (e.g., needles, jewelry, and forceps) that will be prepackaged and sterilized prior to arriving at the venue. *
I confirm that items sterilized at my business location will have the date of sterilization indicated on the package. *
I confirm that copies of the three most recent spore testing results from the sterilizer(s) / autoclave(s) used for sterilization will be on-site. Spore tests must be in English. *
For items sterilized at a business location, provide the name(s) and address(es) of where the items were sterilized.
For items purchased pre-packaged and sterile, provide the name(s) and address(es) of the supplier(s):
Flooring

Soft surfaces (grass, sand, gravel, and mud) require flooring.

Flooring at the event will be*:
Cleaning and Waste Disposal
I confirm that any reusable item will be placed into a puncture-resistant, leak proof container immediately after use. The container will be labelled 'Dirty Items - Do Not Use'. These items will be brought back to the business location for proper cleaning and disinfection. *
I confirm that I will use approved sharps containers for the disposal of all sharps (e.g., needles, razors). All sharps containers will be disposed of in an appropriate manner and not with municipal garbage. *
I confirm that I will maintain tabletops / storage containers in a clean and sanitary manner using*:
Method(s) for garbage waste disposal*:
Method(s) for wastewater disposal*:
Hand Hygiene

All personal service workers must perform hand hygiene before service delivery and as required during and after service.

Client and Vendor Health and Safety
I confirm that I will have an adequate amount of skin antiseptic and clean, single-use, disposable swabs on-site to cleanse the skin prior to any procedure where skin will be punctured such as tattooing and piercing. *
I confirm that I will provide clients with verbal and written after-care information after all invasive procedures. *

I acknowledge*:

This form is adapted with permission from Ottawa Public Health.