This form is for Personal Service Setting Vendors. Please complete and submit this form at least 30 days prior to the event. If you are an event organizer, please refer to our Hosting a Special Event information page. Event Information Event Name * Event Address * Full address, including street number and name, town/city and postal code. Hours of Operation * Vendor Information Business Name * Owner Name * Operator Name * Do you belong to a regulatory college? * Yes No Address * Full address, including street number and name, town/city and postal code. Phone * Email * Vendor Booth Name/Number * Booth location * Indoor Outdoor Aesthetic Services Aesthetic services provided * Yes No If yes, list services to be provided: ServiceEdit Service Single use (disposable) equipment to be used (select all that apply) Wax/Makeup/Tint applicators Buffer blocks/nail files Gloves Toe separators Other, specify: Other specified Reusable equipment to be used (select all that apply) Cuticle nippers Scissors Nail clippers Nail files/Foot files Other, specify: Other specified Note: premises must provide an adequate supply of reusable items or must obtain Public Health approval for on-site cleaning and disinfection of reusable items. Tattoo/Piercing Services Tattooing/Piercing services provided * Yes No Single use (disposable) equipment to be used (select all that apply) Note: if tattooing is to be performed, all items must be single use and disposable. Gloves Dental bibs Razors Sterile needles Piercing jewellery Ink caps Disposable grips/tubes/tips Tattoo stencils Other, specify: Other specified Reusable equipment to be used (select all that apply) Clamps/forceps Other, specify: Other specified Sharps/Garbage Will there be approved sharps containers on site? * Yes No Will you have a lined garbage can with a tight-fitting lid on site? * Yes No Water Supply What will be the source of water on site? * Municipal Bottled Hauled water If hauled water, provide the name and phone number of the hauler: NamePhone Name Phone What method of waste water disposal will be used? * Municipal Other, specify: Other specified Hygiene Practices What type of hand hygiene stations will be available? * Plumbed at booth Portable hand washing station at booth What hand station supplies will be provided (select all that apply)? * Liquid soap in dispenser Paper towel in dispenser Hand sanitizer (70-90% alcohol content) Other, specify: Other specified Cleaning and Disinfecting Disinfectants to be used: Name of disinfectantDrug Identification Number (DIN)/Natural Product Number (NPN)What will disinfectant be used for?Edit Name of disinfectant Drug Identification Number (DIN)/Natural Product Number (NPN) What will disinfectant be used for? Note: all dirty equipment must be stored in puncture proof containers with tight fitting lids and transported back to main business for cleaning, disinfection/sterilization. Dirty equipment must be submerged in water and detergent or enzymatic cleaner. Dirty equipment must be cleaned and disinfected/or sterilized prior to reuse. Additional Comments (optional) Additional Comments (optional) Final Statement By submitting, I agree that I have received and read the Infection Control Checklist for Operating Personal Services at Temporary Events for vendors (opens in new tab). I understand the requirement for temporary personal service vendors at temporary events and have provided the information to all personal service workers that will be working in my booth at the event. I agree that all the information I have provided on the application form is accurate.