Smoking/Vaping Notification Form

Reporting school tobacco/vaping/cannabis offences enables Lambton Public Health to provide early and progressive enforcement of the Smoke-Free Ontario Act, 2017. An Enforcement Officer will respond to offence notifications as soon as possible. Please provide as much information as possible below. All information is private and confidential.

We appreciate your continued efforts to work with us to prevent youth from using tobacco and vapour products and to ensure a safer and healthier school environment. For non-enforcement related inquiries, please contact tobaccofree@county-lambton.on.ca

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Smoke-Free Ontario Act Notification Form

Date of Offence(Required)

Time of Offence(Required)

School Information

School(Required)

Email of Person Submitting the Form(Required)

Student/ Defendant Information

Name of Defendant(Required)

First Middle Last

Date of Birth(Required)

Age on Date of Offence(Required)

(Must be 16 years old or older to be served a ticket)

Please enter a number from 16 to 22.

Address(Required)

Street Address City Postal Code

Offence Information

Type of Offence:(Required)

(Select all that apply)

Smoking/Holding lit tobacco on school property

Smoking/Holding e-cigarette on school property

Smoking/Holding lit cannabis product

Supplying someone under 19 with prohibited item

Note: possession of tobacco or vapour products is not an offence under the SFOA, 2017.)

Location of Offence(Required)

Key Witness(Required)

Other Witness

Details of Offence(Required)

Video evidence of offence?(Required)

Yes

Public Health Action Requested:(Required)

Enroll in Detour Program (first offence only, if available)

Issue warning, or a charge under the SFOA

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Personal information on this form is collected under the authority of the Health Protection and Promotion Act, 1983. Questions about this collection of personal information should be directed to the school principal, the Manager of the Health Promotion for Lambton Public Health 519-383-8331 or the Tobacco Enforcement Supervisor for Lambton Public Health at 519-383-8331 ext 3506.