Personal Service Setting Business Information Form

According to Sec. 3 (7) of O. Reg. 136/18 PERSONAL SERVICE SETTINGS, the following information must be provided to the health unit.

Note:  If there are any changes to the information provided on this form, it is the responsibility of the owner/operator to notify the health unit.

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Please complete this form and forward it by mail or fax to:

Windsor-Essex County Health Unit
Attn: Environmental Health Dept.
1005 Ouellette Avenue
Windsor, ON N9A 4J8
Fax: 519-258-8672

Personal Service Setting Information
Please check reason(s) for submitting this information form:
Services Provided
Please check all that apply
Services
Operator Contact Information
Verification
I acknowledge as the owner/partner/president or signing officer that the information provided on this form is accurate and complete.