Enforcement Report: Selling or Supplying Tobacco or E-Cigarettes to a Person Under 19 Years Old

What are you reporting?

Selling tobacco to a person under 19 years old

Selling E-Cigaretttes to a person under 19 years old

Supplying tobacco to a person under 19 years old

Supplying E-Cigarettes to a person under 19 years old

Your Details

Full Name

Position/Designation

Phone Number

Description of Incident

Date of Offence

Time of Offence

School Name

Address

Details

Person Selling or Supplying Tobacco or E-cigarettes

Full Name

Date of Birth

Address

Parent/Guardian Name

Parent/Guardian Address

Witness Information

1) Witness - Full Name

2) Witness - Full Name

By submitting this form, I testify all information submitted is true and I am aware that I may be required to attend a Provincial Court to testify regarding this offence.

The information on this form is collected under the authority of the Education Act, the Smoke-Free Ontario Act and the Health Protection and Promotion Act in accordance with the Municipal Freedom of Information and Protection of Privacy Act. This information may be used for the delivery of public health programs and services; the administration of the agency; registries and related research, in compliance with legal and regulatory requirements. Questions about collection of this information should be addressed to Client and Community Support at 1-800-265-7293 ext. 7006 or clientcommunitysupport@wdgpublichealth.ca.

Enforcement Report: Selling or Supplying Tobacco or E-Cigarettes to a Person Under 19 Years Old

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