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Schools & Child Care

School Witness Report

***For staff and school administrators completing the school witness report. By providing the following statement of facts, you acknowledge that you will be called as a witness in the event of a trial made under the Smoke-Free Ontario Act, 2017 and the regulations therein. ***

This form should only be completed after school and/or board disciplinary actions have been taken.

This form data is intended only for the use of the named addressee and may contain information that is confidential or privileged. You are hereby notified that any dissemination, distribution or copying of this form data is strictly prohibited.

We only accept and process witness reports for Simcoe County and District of Muskoka schools.

Please:

  • Only submit each report once. To prevent resubmission please close your browser.

Submissions are processed in the order of submission dates. Our turn around time is 3-4 business days from date of submission. You will receive an email notification once your matter has been assigned to a tobacco enforcement officer.

Please complete all fields marked with an * asterisk.

* By clicking this button you acknowledge that your attendance in court may be required as a witness to support any charge(s) laid based on your information below.
YYYY-MM-DD (e.g., 2022-05-15)
To be completed by witness (i.e., school administrator, teacher, staff member, other)
YYYY-MM-DD (e.g., 2022-05-15)
(e.g., 02:10 PM)
(address of school and place on school property where offence occurred)
Offender/Suspect Information (details of person committing offence)
YYYY-MM-DD (e.g., 1980-01-21)
* Offence Observed (check all that apply):






* Description of age-restricted product.

For vapour product(s), please include as much information as possible due to court/legal requirements, including:
a) Name of vapour product
b) Vape flavour
c) Type of vapour product (i.e., disposable, pen, pod(s), pod kit, etc.)
d) Brand name of vapour product
e) Nicotine level of vapour product
f) Other identifying details including where it was obtained (if known)

For tobacco product(s), please include as much information as possible due to court/legal requirements, including:
a) Name of tobacco product
b) Type of tobacco product (i.e., cigarettes, cigarillos, etc.)
c) Brand name of tobacco product
d) Other identifying details including where it was obtained (if known)

For cannabis product(s), please including as much information as possible due to court/legal requirements, including:
a) Name of cannabis product
b) Cannabis flavour (if any)
c) Type of cannabis product (i.e., joint, vape, pipe, etc.)
d) Brand name of cannabis product
e) Other identifying details including where it was obtained (if known)

Other Persons Involved in the Offence: (include name and complete a separate report)
To be completed by school administrator
* This is a (check one)


* We wish to proceed with (check one)




 
* I have reviewed the above for accuracy.
* Picture of Age-Restricted Product (i.e. vape, cigarette, cigarette pack, joint)

Upload Picture of Age-Restricted Product
NOTE: We cannot accept Microsoft Word files. Only image (jpg, jpeg, and png) or Adobe PDF.
“The Health Unit collects personal information in the course of doing business. Personal information about you is collected directly from you or from the person acting on your behalf. Personal health information collected may include, for example, your name, date of birth, address, contact information, health card number, health history, and information you provide during visits or calls to the health unit.”
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If you have any questions or concerns that require a response, please contact Health Connection directly.

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