The Health Protection and Promotion Act and related Public Health Statutes an Overview

1. The Health Protection and Promotion Actand related Public Health Statutesan Overview alPHa Board of Health Orientation Session February 5, 2015 Liam Scott, CounselLegal Services BranchMinistry of Health and Long-Term Care

2. Outline • Health Protection and Promotion Act (HPPA) • Local and Provincial roles and authorities • Ontario Public Health Standards / Accountability Agreements • Reporting Requirements • Fluoridation Act • Immunization of School Pupils Act

3. Health Protection and Promotion Act • HPPA Role, Authority and Powers of: • Local boards of health • Local medical officers of health (MOH) and public health inspectors • Chief Medical Officer of Health (CMOH) • Associate CMOHs • Minister of Health and Long-Term Care • HPPA Reporting Requirements

4. Local Medical Officers of Health / BOHs • 36 health units: • Each with a medical officer of health (qualifications set out in O. Reg. 566 – s. 1(1)) • Each with a board of health – • Reg. 553 (Areas Comprising Health Units) and • Reg. 559 (Designation of Municipal Members of BOH) • Independent of the Government of Ontario. Not Crown agents.

5. Local Medical Officers of Health / BOH (cont’d) Other key provisions setting out relationship between MOH and BOH: • Local MOH reports to the BOH on all public health programs and services under HPPA and any other Act (s. 67(1)) • Staff of the health unit are responsible to the MOH for public health programs and services. (s. 67(2)) • MOH is responsible to the BOH for the management of health programs and services under the HPPA and any other Act. (s. 67(3)) Note other key provisions affecting BOH governance: • Every board of health is a corporation without share capital (s. 52) • Requirement to keep financial records and prepare annual financial reports (s. 59) • By-laws must be made respecting: (s. 56) • The management of its property • Banking and finance • Calling of and proceedings at board meetings • The appointment of an auditor

6. Local Medical Officers of Health / BOH (cont’d) Appointment of BOH Members • Municipal member limit. Must be no fewer than 3 and not more than 13 municipal members of boards of health (s. 49(2)) • Provincial member limit. Province (Lieutenant Governor in Council) may appoint members, but the number of provincial members must be less than the number of municipally appointed members. (s. 49(3)) Provincial Members may be appointed for 1, 2 or 3 years (s. 51(1)) • Payment and Expenses. Remuneration and reasonable expenses to be paid by board of health to members (s. 49(4) and (5)) Note though that if member is a member of council, then no payment unless that person is the Chair (s. 49(11)). • Rate of Payment. Rate of remuneration cannot be higher than the rate paid to a member of a standing committee of a municipality within the health unit (s. 49(6)) • Term of Municipal member.Termcontinues during the pleasure of the council that appointed the member and ends (unless ended sooner) with the ending of the term of council office. (s. 49(8)) • Non- Application. The above sections do not apply to BOHs that are established as Regional Municipalities (e.g., Durham, Halton, Niagara, Peel) or by or continued under City-specific Acts (e.g., City of Hamilton, County of Norfolk)

7. Local Medical Officers of Health / PHIs • Two types of orders that may be made under the HPPA: • Health hazard orders (s. 13 of the HPPA) • Communicable disease orders (s. 22 of the HPPA) • Health Hazard Orders (s. 13) • Every MOH must inspect the health unit in his or her community for the purpose of preventing, eliminating and decreasing the effects of health hazards in that community (s. 10). • Where there may be a potential health hazard, a MOH or a local public health inspector may make a s. 13 order, which may (s. 13(4)): • Require vacating premise • Require removal, cleaning, or disinfecting • Require destruction of the matter or thing specified in the order • Requiring the placarding of premises to give notice of an order • Orders may be appealed (within 15) days to the Health Services Appeal and Review Board. • Also note other related provisions in the HPPA related to health hazards: • Seizure of things (other than people) that are health hazards (s. 19) • Prohibition on unpasteurized or unsterilized milk (s. 18)

8. Local Medical Officers of Health / PHIs (cont’d) • Communicable Disease Orders (s. 22) • Under section 22(1) of the HPPA, where the requirements of section 22(2) are met, MOHs may make an Order in writing requiring the person who is the subject of the order to do or to stop doing, any action specified in the order in respect of a communicable disease. • The legal test, set out in section 22(2) of the Act, is that the MOH must be of the opinion, upon reasonable and probable grounds: • that a communicable disease exists or may exist or that there is an immediate risk of an outbreak of a communicable disease in the health unit served; • that the communicable disease presents a risk to the health of persons in the health unit; and • that the requirements specified in the order are necessary in order to decrease or eliminate the risk to health. • Orders may be appealed to HSARB within 15 days (same as for health hazards.)

9. Local Medical Officers of Health / PHIs (cont’d) Other local MOH / PHI powers and duties in the HPPA: • For complaints related to environmental and occupational health, MOH must notify the Government of Ontario ministry having primary responsibility and investigate the complaint. (s. 11) • Duty on MOH to keep him/herself informed as to occupational and environmental health (s. 12) • MOH may vary requirements in regulations for small drinking water systems or establish interim requirements for owners and operators of small drinking water systems (s. 12.1) • Recovery of expenses from owner or operator from a court of competent jurisdiction or by notification to municipal clerk (where unpaid after 60 days) – recovery as municipal taxes (s. 15) • Prohibition on sale of diseased (adulterated) food unfit for human consumption (s. 17) • Unpasteurized milk and cream prohibition (s. 18) • Seizure by local MOH of any substance, plant, thing, or animal pending examination or investigation. (s. 19) Permits destruction where the thing is a health hazard (s. 19)

10. Role and Authority of the CMOH • Chief Medical Officer of Health (s. 81) • Terms of Appointment • Appointed by the Lieutenant Governor in Council on address of the Legislative Assembly • Holds office for a term of 5 years, and may be reappointed • Must be a physician of at least 5 years and possess the qualifications prescribed by the regulations (O. Reg. 566, s. 1) • Responsibilities • Must stay informed in respect of occupational and environmental health matters • Must deliver an annual report on the state of public health in Ontario to the Legislative Assembly (required to submit to the Minister of Health and Long-Term Care 30 days in advance) • May make any other reports respecting public health as he/she considers appropriate and may present this report to the public (e.g. H1N1 Report in September 2011, Report on Wind Turbines in 2010)

11. Role and Authority of the CMOH (cont’d) • Associate Chief Medical Officer of Health (s. 81.1) • Terms of Appointment • Position held by person or persons who, by virtue of their position, hold the title of “Associate Chief Medical Officer of Health” in the Ministry. • Must be a physician of at least 5 years and possess the qualifications prescribed by the regulations. • Responsibilities • Shall perform such functions and duties as the CMOH may specify in writing. • Shall act in the place of the CMOH when: • the CMOH is absent • the CMOH is unable to perform the functions of his//her office • the office of CMOH is vacant • The functions, powers and duties of the Associate Chief Medical Officer of Health may be clarified, modified or restricted by regulation. (There are no regulations)

12. CMOH Powers CMOH may act where risk to health (s. 77.1) • Where the CMOH is of the opinion that there is a risk to health, he or she may investigate the situation and take such action as is necessary to prevent, eliminate or decrease the risk. In doing so, the CMOH may: • exercise any of the powers of a board of health or of a medical officer of health, including the power to appoint a medical officer of health or an associate medical officer of health • direct a person whose services are engaged by a board of health to do any act that the person has the power to do, or that the medical officer of health has the authority to direct the person to do • Power has been exercised infrequently (e.g., Rubella outbreak in Oxford County in 2005, Dissolution of Muskoka-Parry Sound BOH in 2005). Application to judge where risk to health (s. 77.2) • Where the CMOH is of the opinion that there is, or may be a risk to health, he or she may apply to a judge of the Superior Court of Justice for an order requiring a board of health to take such action as the judge considers appropriate to prevent, eliminate or decrease the risk. (This power has not been exercised to date)

13. CMOH Powers (cont’d) Request to Board of Health for Information (s. 77.3) • The CMOH may require a board of health to provide such information as the CMOH specifies about the board of health and the health unit served by the board. Can’t include identifiable or personal health information – that is covered by section 77.6 below.) Order to Provide Information (s. 77.6) • The CMOH may direct any health information custodian (as defined in the Personal Health Information Protection Act, 2004) to supply the CMOH with any information specified, including personal health information, where he/she is of the opinion that: • there is an immediate and serious risk to the health of persons, AND • the information is necessary to investigate, eliminate or reduce the risk, AND • The information supplied must be no more than is reasonably necessary. • The information must only be used or disclosed to investigate, eliminate or reduce the risk. • This power was added to the HPPA in 2007.

14. CMOH Powers (cont’d) Directives (s. 77.7) • Where the CMOH is of the opinion that there is or may be an immediate risk to health, he/she may issue a directive to any health care provider or entity respecting precautions and procedures to protect the health of persons. • Where the CMOH is of the opinion that there may be an outbreak of an infectious or communicable disease, and the directive relates to worker health and safety in the use of protective items, the CMOH must consider the precautionary principle. • The directive may not be used to compel regulated health professionals to provide services without their consent. • Added to the HPPA in 2007. • Note - New power for CMOH (s. 77.9) added to the HPPA on May 4th, 2011. This power allows the CMOH to issue directives to local boards of health and local medical officers of health under certain emergency-type conditions on policies and measures to ensure consistency in public health. (e.g. priority groups for immunization clinics.)

15. CMOH Powers (cont’d) Directives (s. 77.7) (continued) “health care provider or health care entity” means: • A regulated health professional or a person who operates a group practice of regulated health professionals. • A service provider within the meaning of the Long-Term Care Act, 1994 who provides a community service to which that Act applies. • A community care access corporation within the meaning of the Community Care Access Corporations Act, 2001. • A hospital within the meaning of the Public Hospitals Act, a private hospital within the meaning of the Private Hospitals Act, a psychiatric facility within the meaning of the Mental Health Act, an institution within the meaning of the Mental Hospitals Act or an independent health facility within the meaning of the Independent Health Facilities Act. • A pharmacy within the meaning of Part VI of the Drug and Pharmacies Regulation Act. • A laboratory or a specimen collection centre as defined in s. 5 of the Laboratory and Specimen Collection Centre Licensing Act. • An ambulance service within the meaning of the Ambulance Act. • A paramedic under the Ambulance Act. • A home for special care within the meaning of the Homes for Special Care Act. • A nursing home under the Nursing Homes Act, a home under the Homes for the Aged and Rest Homes Act, or a charitable institution under the Charitable Institutions Act. • A centre, program or service for community health or mental health whose primary purpose is the provision of health care. • A prescribed person or entity; (“fournisseur de soins de santé ou entité chargée de la fourniture de soins de santé”)

16. CMOH Powers (cont’d) Collection of specimens and test results (s. 77.8) • Where the CMOH is of the opinion that there is an immediate and serious risk to health, in order to investigate, eliminate or reduce the risk to health, he/she may: • collect, retain and use any previously collected lab specimens, and information or test results related to previously collected lab specimens • order the production of the previously collected specimens and test results • The CMOH may not compel an individual to provide a bodily sample or submit to tests without the individual’s consent. • Added to the HPPA in 2007.

17. CMOH Powers (cont’d) Authorization or direction of CMOH (s. 86.3) • Where authorized by the Minister in writing, the CMOH has the power to exercise the following: • to appoint assessors to carry out an assessment of a board of health (s. 82) • to give directions to a board of health (s. 83) • to take steps to ensure the direction in s. 83 is carried out (s. 84) • to give a board of health a notice of failure to comply with directions (s. 85)

18. Minister Powers Publishing Guidelines for the Provision of Mandatory Health Programs and Services (s. 7) • The following Standards are funded by the Public Health Division of the MOHLTC: • Foundational • Infectious Diseases • Environmental Health • Emergency Preparedness • The following Standards are funded by the Health Promotion Division of the MOHLTC: • Chronic Diseases and Injuries • Family Health • Ministry of Children and Youth Services funds the Healthy Babies Healthy Children Program • Guidelines must be provided to Boards of Health and be available for public inspection in the Ministry (s. 7(2))

19. Minister Powers (cont’d) • Guidelines are not regulations (i.e. no Cabinet approval needed for changes – not published in the Ontario Gazette) but amendments to them need to be approved by the Minister. (s. 7(3)) • Protocols are incorporated into the OPHS. Rolling incorporation means that a reference to a protocol is a reference to it as amended from time to time. (i.e. updates to protocols do not need Minister approval.) Any amendment to protocols or standards must be provided to the local board of health prior to taking effect. • The Minister of Health and Long-Term Care may publish the Guidelines (s. 7 of HPPA). [Known as the Ontario Public Health Standards (OPHS).] Refer to Appendix A

20. Minister Powers (cont’d) Making Certain Regulations (s. 97) • Minister may make regulations: • Specifying diseases as reportable, communicable and virulent • Specifying diseases for purposes of “immunizing agents” (s. 38) • All other regulations (listed in section 96) may be made by the Lieutenant Governor in Council (e.g. Provincial Cabinet). Grants to Boards of Health (s. 76) • The Minister may make discretionary grants for the purposes of the HPPA on such terms and conditions as the Minister considers appropriate. • This is the authority to provide provincial grant funding to BOH. This allows Minister to specify terms and conditions in Accountability Agreements with the boards of health.

21. Minister Powers (cont’d) Appointment of Assessors (s. 82) • Power of the Minister to appoint assessors. (CMOH also authorized to exercise this power.) Assessors may carry out an assessment for purposes of: • Determining whether a board of health is providing health programs and services specified in the HPPA • Determining whether a board of health is complying in all respects with the HPPA and the regulations • Ascertaining the quality of the management or administration of the affairs of the board of health. • Assessments may be “for cause” or random. The Act doesn’t specify one way or the other. • Assessments of BOHs are infrequent. Recent assessment ordered by the Minister in respect of Algoma’s Board of Health.

22. Minister Powers (cont’d) Minister Approvals • Minister must approve: • All MOH and Associate MOH appointments (s. 64(c)) • Any dismissal of a MOH or an Associate MOH by the board of health (s. 66) • Note: As of 2011, Minister and CMOH must approve acting MOH appointments that are more than 6 months. • Minister may approve: • Qualifications of a business administrator or public health nutritionist (if knowledge and experience are deemed equivalent) (s. 2(1)(c), s. 7(1)(c) of O. Reg. 566) • Qualification for an MOH or Associate MOH for post-graduate public health requirement, if qualifications obtained from a university outside Canada is considered equivalent to Canada. (s. 1(1)(c) of O. Reg. 566)

23. Minister Powers (cont’d) Minister powers to enter into agreements • Health services in isolated municipalities not within a health unit (s. 89) • Minister and municipality may enter into an agreement to provide health programs and services that a board is otherwise required to provide under the HPPA. • Agreements with organizations for areas not in a health unit (s. 91) • Accountability Agreements (s. 81.2)

24. Funding of Boards of Health • Part of the responsibility of a board of health includes establishing the budget for the public health unit. • Under section 72 of the HPPA, obligated municipalities are required to pay the expenses of boards of health and public health units. • Section 72(5) – BOH gives notice to obligated municipality of expenses payable. • Section 72(6) – BOH can send a supplementary notice for unanticipated expenses. • Section 72(8) – An obligated municipality that receives a notice must pay the notice in the time set out in the notice. (No discretion not to pay.) • Section 100 – It is an offence for an obligated municipality to fail to pay a notice issued by a BOH. • The ministry is not legally obliged to provide funding, but may make grants for the purposes of the HPPA (section 76).

25. Funding of Boards of Health (cont’d) • The ministry currently cost-shares the expenses of public health units with municipalities for the delivery of mandatory programs (OPHS) at 75% of the ministry approved allocation. • The ministry also provides 75% and 100% provincial funding for a number of related public health programs and services (e.g., Healthy Smiles Ontario Program, Smoke-Free Ontario Program). • Funding for mandatory and related programs is typically based on a calendar year (municipal fiscal year); funding decisions are made upon ministry review of budget submissions from boards of health and Minister’s approval. • If the board of health’s total approved budget exceeds the ministry’s approved funding, then the obligated municipalities are responsible for those costs.

26. Accountability Agreement • A signed formal, legal agreement is required between a board of health and the ministry as a condition of funding approval. • Ministry funding for mandatory and related programs is governed by the Public Health Funding and Accountability Agreement (Accountability Agreement), which came into effect on January 1, 2014 and sets out the obligations of the ministry and boards of health. • Includes most of the funding provided by the Province to boards of health with a few exceptions (e.g., Healthy Babies Healthy Children). • The Accountability Agreement incorporates financial reporting requirements, performance indicators, and continuous quality improvement tools. • Performance indicators: • Are program-based and focus on board of health outcomes. • Have targets that are negotiated between individual boards of health and the ministry. • Performance expectations and financial data are refreshed annually and additional measures may be incorporated in the Accountability Agreement to address issues specific to certain boards of health. • The Accountability Agreement will remain in effect unless terminated according to the specific articles of the Accountability Agreement. • The Accountability Agreement will be reviewed every 5 years to determine if amendments are required.

27. Accountability Agreement (cont’d) Key Provisions of Note in the Agreement • Grant (Article 4) – highlights: • Provincial grant provided for purposes of carrying out obligations in the Act, regulations, the Ontario Public Health Standards and Ontario Organizational Standards (see Appendix B), as well as the requirements set out in the Agreement • Province may adjust the amount of Grant it provides to the Board of Health in any funding year based on financial reports • Province does not have to make payments where no appropriation from the Legislature (requirement of law under the Financial Administration Act.) • Performance Improvement (Article 5) – Sets out the elements of the performance improvement process including measurement and monitoring of performance indicators for boards of health against established targets. Also includes provisions for performance and compliance reporting. • Disclosure of COIs to the Province (Article 7) – Differs from municipal COI requirements. Required to disclose “any situation that a reasonable person would interpret as either an actual, potential or perceived COI.” • Reporting, Accounting and Review (Article 8) – Requires boards of health to submit reports to the province; authorizes the ministry to conduct an inspection, audit or investigation of the board. • Schedules (Article 27) – Includes Schedule A (Program-Based Grants), Schedule B (Policies and Guidelines), Schedule C (Reporting Requirements), Schedule D (Performance Obligations), and Schedule E (Board of Health Financial Controls). Amendments during term are made to the Schedules to reflect: a) updated allocations, b) new policies and guidelines, c) new reporting requirements, d) updated performance indicators, baselines and targets, and updated financial controls.

28. HPPA – Reportable Diseases Reportable Diseases and the Duty to Report (ss. 25 to 31 of HPPA) • The statutory duty of reporting cases of diseases to the local MOH is found within the mandatory reporting provisions under Part IV, the Communicable Diseases section of the HPPA. • The duty extends to, among others, school principals, hospital administrators, nursing home administrators, superintendents of certain specified institutions (e.g. correctional facilities, day nurseries) and operators of laboratories, pursuant to sections 25 to 31 of the Act • In particular, section 25 of the HPPA places a mandatory reporting requirement on physicians and certain other regulated health professionals, including dentists, nurses, pharmacists, to report a patient who “has or may have a reportable disease”. • Reports Regulation (O. Reg. 569) specifies content of mandatory reports for each disease and indicates that local medical officers of health must report reportable diseases to the Public Health Division of the Ministry using iPHIS “or any other method specified by the Ministry”. LGIC (Cabinet) regulation. • O. Reg. 558/91 (Communicable Diseases) and 559/91 (Reportable Diseases) (Minister’s regulations)

29. Fluoridation Act • Establishes the ability for municipalities to fluoridate their municipal water systems • Council of local municipality (or regional municipality) may by by-law require the operation of a fluoridation system for municipal water system or may submit the question to electors before passing the by-law (ss. 2, 2.1) • Council may discontinue the fluoridation system by by-law or by a vote of electors prior to passing the by-law. (s. 3) • For joint waterworks (for two or more municipalities), the fluoridation system can only be operated where a majority of the municipalities pass a by-law requiring fluoridation of the water supply. (s. 5.) • If council obtains it water supply from a public utility company, then the council can pass a by-law, and the company must establish it. If the company and council cannot agree on the terms and conditions for establishing the fluoridation system, then arbitration may take place under the Arbitration Act. (s. 6) • Regulation making powers under the Act (s. 9) (e.g. governing and regulating fluoridation equipment, prescribing nature of chemical compounds) – there are no regulations. In a claim filed in September of 2014 against both Ontario and the Region of Peel, the Plaintiff seeks a declaration that the Fluoridation Act violates s. 7 of the Charter of Rights and Freedoms and is of no force or effect.   Declarations being sought against Peel include Peel’s alleged failure to ensure safety of the municipal drinking water supply, and seeking an injunction to stop Peel from fluoridating drinking water in municipal water supplies. Stay tuned! 

30. Public Health Ontario (PHO) • Established by legislation in 2007 (Ontario Agency for Health Protection and Promotion Act). • Also known as Ontario Agency for Health Protection and Promotion. • It is a corporation (without share capital.) Objects are noted in s. 6 of the legislation – include promoting public health knowledge, best practices, public health research, etc. • Board consists of no more than 13 people appointed by the LGIC. (s. 9) • Board may pass by-laws and resolutions to conduct and manage the affairs of PHO. (s. 13) • Certain Board powers cannot be exercised without approved by the LGIC – including acquiring, disposing, leasing or mortgaging real property, borrowing or lending money, investing money, pledging, charging or encumbering any of its real property or creating subsidiaries. (s. 7(4)) • CMOH is not a board member, but can attend board meetings. CMOH is a member of PHO’s Strategic Planning Committee. • Requirement for PHO to provide: a) annual business plan, b) annual report, c) annual audited report. • CMOH can issue directives (in writing) to PHO for PHO to provide scientific and technical advice and operational support to any person in an emergency or outbreak situation.

31. Immunization of School Pupils Act • Immunizations. Requires parents of school pupils to provide the local Medical Officer of Health (MOH) with proof of child’s immunization against 6 designated diseases in legislation: diphtheria, tetanus, polio, measles, mumps, rubella. Note that in 2013, the following additional designated diseases were added in the regulations: meningococcal disease, pertussis and varicella. • Program of Immunization. Program of Immunization set out in the Table in Regulation 645 (General) under the ISPA. • Exemptions. Exemptions can be granted to immunization requirements if the parent files with the local MOH one of the following: • A statement of medical exemption; or • A statement of conscience or religious belief. • Responsibilities of MOHs/Schools re: medical records. MOHs have responsibility to maintain records of immunization for all school pupils within their jurisdiction. (s. 11). Regulation since 2013 requires reports from schools upon the request of the medical officer of health (see s. 1.1 of Regulation 645 (General)). Note that Ontario Education Number (OEN) must now be disclosed by schools, but subject to the requirements of s. 1.1(5). Amendments in 2013 to the regulation intended to assist with implementation of Panorama immunization module. • Types of Orders. Two kinds of orders may be made by MOH: • Suspend a pupil for a period of up to 20 school days (if no exemption form or statement from physician as to immunization). (s. 7) Must provide reasons for the suspension (s. 8(2)); or • Make an order excluding an unimmunized pupil from school if the MOH believes, on reasonable and probable grounds, that there is an outbreak or an immediate risk of an outbreak of a disease where the pupil attends. (s. 12) • Appeal of Order. Appeal is available to the Health Services Appeal and Review Board within 15 days after notice is provided.

32. Other Immunization Statutes Day Nurseries Act (DNA) (Ontario Regulation 262 – ss. 31, 33, 48) Note: DNA will be repealed and replaced by the Child Care and Early Years Act, 2014 – Bill 10 – Royal Assent in December 2014 (on a date set by Proclamation of the Lieutenant Governor). In the current regulations under the Day Nurseries Act: • Requires operators of day nurseries to ensure that all children admitted to the day nursery are immunized in accordance with recommendations by the MOH, unless a medical exemption or statement of conscience or religious belief is provided to the operator. • If a child becomes ill, the child must be separated from other children, and the illness noted in the child’s record. (Records of staff and students must be maintained for 2 years.) • Records must be provided to the MOH for inspection upon request. Health Protection and Promotion Act (HPPA) • Requires MOH to provide mandatory programs and services, including immunization services to children and adults (s. 5, para. 2). • Requires health care providers to report any incidence of an Adverse Event Following Immunization (AEFI) in respect of any immunizing agent to their local MOH (within 7 days), and for the MOH to report it to the Ministry of Health and Long-Term Care (O. Reg. 569 – Reports under the HPPA – s. 8)

33. Skin Cancer Prevention Act (SCPA) • Introduced on March 7th, 2013. Royal Assent on October 10, 2013. Came into force on May 1st, 2014. • Key components: • No tanning under age 18. Prohibits the sale (including offering for sale or providing for consideration) of tanning services or UV light treatments for tanning to anyone under 18 years of age. • Must ask for I.D. Tanning bed operators are required to ask for I.D. for anyone who appears to be 25 or under. • No directing advertising or marketing to persons who are under age 18. • No self-tanning. Bans self-tanning or tanning without the presence of an attendant. (All ages) • Post signs. Sign requirements in any place where tanning or UV light treatments are sold. • Protective eyewear. Persons who sell tanning services must ensure protective eyewear is used. • Tell us that you are opening a tanning business. Notice to local medical officer of health that a tanning business is opening of name, address and telephone number. Existing tanning businesses have 60 days to comply. • Minister appoints inspectors. Standard inspection powers – including entry without a warrant unless dwelling, inspection and copying of records. Tickets can be issued under Part I of the Provincial Offences Act. Fines in Act are $5000 for individual, $25,000 for corps for every day or part of a day. (Consistent with other public health legislation.)

34. Skin Cancer Prevention Act (Regulation) Highlights of Regulation 99/14 under the Skin Cancer Prevention Act: • Defines “tanning services” to exclude spray tanning. • Outlines requirements for ID (e.g. driver’s license, or other photo ID such as a Health Card or Passport.) • Outlines requirements for signs (point of sale warning sign (at register), health warning sign (in rooms where tanning beds are located), age restriction decal (on front door of tanning business), employee reminder decal (sticker for employees.) • Restricts marketing and advertising targeted at those under age 18 and advertising that is false or misleading (e.g. advertising in media or publications targeted at children – such as a high school yearbook, or depictions such as cartoon characters directed at children, or advertising saying that tanning is healthy for your skin.) Inspectors are currently enforcing this Act. Ministry is monitoring enforcement by its inspectors. A high level of compliance is expected by tanning operators based on experiences in other jurisdictions (most other jurisdictions in Canada have tanning laws for youth with the exception of Alberta.)

35. Appendix A: Ontario Public Health Standards Establish requirements for fundamental public health programs and services: articulated in 14 standards, 148 requirements and 27 protocols.

36. Appendix B: Organizational Standards • The Organizational Standards outline expectations for the effective governance of boards of health and effective management of public health units. • The Standards contain expectations of both the board of health as the governing body (first 5 categories) and the public health unit as the administrative body (final category entitled Management Operations). • The Organizational Standards include the following six categories: 1. Board Structure (8 requirements) 2. Board Operations (10 requirements) 3. Leadership (3 requirements) 4. Trusteeship (3 requirements) 5. Community Engagement & Responsiveness (5 requirements) 6. Management Operations (15 requirements)