Required fields are marked with asterisks (*)

Personal Service Setting Special Event Vendor Application Form

Special events in the City of Ottawa that offer personal services on site must comply with all applicable sections of the Health Protection and Promotion Act, Ontario Regulation 136/18 Personal Service Settings.

Special events include conventions, expos, shows, and fairs.

You must notify Ottawa Public Health by completing and submitting the Vendor Application a miniumum of 14 days prior to the event.

Business Information

Business Name:

Street Address:

City:

Postal Code:

Owner / Operator Information:

Owner / Operator First Name:

Owner / Operator Last Name:

Primary Phone Number:

Cell Phone Number:

Email Address:

Alternate Contact:

Alternate Contact First Name:

Alternate Contact Last Name:

Primary Phone Number:

Cell Phone Number:

Email Address:

Event Information

Is this your first time providing personal services at a special event?

Yes, this will be my first time providing personal services at a special event

No, this will not be my first time providing personal services at a special event

Will you be attending more than one event?

No, I am only providing services at one event

Yes, I am providing services at additional events in the Ottawa Region

Vendor Set Up:

Indoor booth

Indoor mobile unit

Outdoor booth

Outdoor mobile unit

Types of services I will be offering at the event:

Invasive procedures

Non-invasive procedures

Invasive and non-invasive procedures

Will services be provided to the public?

Yes

No (demonstration only with model)

Instruments and Sterilization

Reprocessing / sterilization of instruments is not permitted onsite.

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

I will only be using single-use disposal instruments at this event.

Yes

Not Applicable

I will transport clean and sterilized equipment in labelled containers.

Yes

Not Applicable

I will have instruments requiring sterilization (e.g., needles, jewelry, and forceps) that will be prepackaged and sterilized prior to arriving at the venue.

Yes

Not Applicable

Items sterilized at my business location will have the date of sterilization indicated on the package.

Yes

Not Applicable

Copies of the three most recent spore testing results will be on site from the sterilizer(s) / autoclave(s) used for sterilization. Spore tests must be in English.

Yes

Not Applicable

For items sterilized at a business location, provide the name and address of where the items were sterilized.

Add location Remove this location

For items purchased pre-packaged and sterile, provide the name and address of the supplier(s):

Add location Remove this location

Flooring

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

Flooring at the event will be:

Plywood

Rubber mats

Pavement

Other

Cleaning and Waste Disposal

Any re-useable 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 acknowledge the above statement:

Yes

Not Applicable

I will use an 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.

Yes

Not Applicable

I will maintain tabletops / storage containers in a clean and sanitary manner using:

Bleach and water solution

Quaternary ammonium solution

Other

Method(s) for garbage waste disposal:

Waste disposal coordinated by event organizer

Waste disposal on site

Waste disposal off site

Method(s) for wastewater disposal:

Wastewater disposal coordinated by event organizer

Wastewater disposal on site

Wastewater brought off site

Hand Hygiene

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

Client Vendor Health and Safety

I will have an adequate amount of skin antiseptic and clean, single-use, disposable swabs onsite to cleanse the skin prior to any procedure where skin will be punctured such as tattooing and piercing.

Yes

Not Applicable

I will provide clients with verbal and written after-care information after all invasive procedures.

Yes

Not Applicable

I acknowledge:

I will maintain client records for all services provided

I will maintain records of accidental blood and body fluid exposures

I understand that non-compliance with OPH requirements may result in service interruption and / or closure

Additional Comments:

Form Builder

Personal Service Setting Special Event Vendor Application Form

Business Information

Owner / Operator Information:

Alternate Contact:

Event Information

Instruments and Sterilization

Flooring

Cleaning and Waste Disposal

Hand Hygiene

Client Vendor Health and Safety

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