"*" denotes mandatory fields.
 
 
 
Contact Information
 
 
 
First Name*
 
 
 
Last Name*
 
 
 
Organization*
 
 
 
Organization Email*
 
 
 
Confirm Organization Email*
 
 
 
 
 
 
 
 
Municipal Alcohol Policy (MAP) Information
 
 
 
Please provide a link to your Municipal Alcohol Policy*
 
 
Note: If you wish to provide more than one link, please complete a second intake form. We do not accept submissions via email.
 
 
 
When was your MAP implemented?*
 
 
 
 
Note: If you do not know the exact dates, please enter the first day of the month.
 
 
 
Has your MAP been revised since initial implementation?*
 
Yes
No
 
If yes, when?*
 
 
 
 
 
Has your MAP been evaluated/assessed?*
 
Yes
No
 
If yes, when?*
 
 
 
 
 
Was your MAP evaluated/assessed against the CAMH Blue Ribbon Criteria?*
 
Yes
No
 
 
 
If yes, enter your Blue Ribbon Score*
 
 
 
 
 
 
 
Was your MAP evaluated/assessed using other tools?*
 
Yes
No
 
 
 
If yes, provide a list of evaluation/assessment tools you used.*
 
 
 
 
 
 
Do you give PHO permission to share your Municipal Alcohol Policy externally for educational purposes on the Public Health Ontario website?*