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Hospital and Long-Term Care Facilities Incident Report

Smoke Free Ontario

This online Hospital and Long-Term Care Facilities Incident Report form offers hospital and long-term care facility staff and/or Ottawa residents a quick, convenient, and secure way to report violations of the Smoke-Free Ontario Act, 2017 that occur on hospital and long-term care property.

Please complete and submit one form per person observed.

Please also ensure that you have submitted the form successfully. All mandatory fields need to be filled. Once submitted, a confirmation window will appear.

Please note:

Smoking refers to the smoking or holding of lighted tobacco or cannabis (includes medical).

Vaping refers to inhaling or exhaling vapour from an electronic cigarette/vape or holding an activated electronic cigarette/vape, whether or not the vapour contains nicotine or cannabis.

Disclaimer: This information is being collected pursuant to the Smoke-Free Ontario Act, 2017 and will be retained, used, disclosed and disposed of in accordance with the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c.M.56, and all applicable federal and provincial legislation, and regulations governing the collection, retention, use disclosure and disposal of information. Any questions regarding this collection may be directed to

Description of Alleged Offence

Person Observed

Witness(es) Information


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