Required fields are marked with asterisks (*)

International Agricultural Workers Housing Inspection

This form is for employers bringing international agricultural workers (IAWs) into the region as agriculture and food processing employees. It must be submitted to Huron Perth Public Health to notify us of new IAW arrivals and to request inspections of IAW housing.

Contact information

Farm name:

Name of Farm Owner:

Name of Primary Operator (Day to Day contact):

Phone number:

Email address:

How would you like to be contacted?

Phone

Both

Inspection Location(s):

Please provide information on the locations/accommodations by completing the list below:

Address (Street number/911 number and name)

P.O. Box number

City/Town

Postal code

Has this dwelling been previously inspected by the health unit?

Yes

Type of water system:

Type of sewage system:

Address (Street number/911 number and name)

P.O. Box number

City/Town

Postal code

Has this dwelling been previously inspected by the health unit?

Yes

Type of water system:

Type of sewage system:

Address (Street number/911 number and name)

P.O. Box number

City/Town

Postal code

Has this dwelling been previously inspected by the health unit?

Yes

Type of water system:

Type of sewage system:

Address (Street number/911 number and name)

P.O. Box number

City/Town

Postal code

Has this dwelling been previously inspected by the health unit?

Yes

Type of water system:

Type of sewage system:

Address (Street number/911 number and name)

P.O. Box number

City/Town

Postal code

Has this dwelling been previously inspected by the health unit?

Yes

Type of water system:

Type of sewage system:

By checking this box, I acknowledge I have read, understand, and agree that the information provided in this form is correct.

Yes

The personal information on this form is collected under the authority of The Health Protection and Promotion Act, R.S.O. 1990, c. H. 7. It will be used for ownership identification and enforcement of the Act and the applicable Regulations under the Act.

Forms

International Agricultural Workers Housing Inspection

Contact information

Inspection Location(s):