"*" 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?
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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?
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Yes
No
If yes, when?
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Has your MAP been evaluated/assessed?
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Yes
No
If yes, when?
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Was your MAP evaluated/assessed against the CAMH Blue Ribbon Criteria?
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Yes
No
If yes, enter your Blue Ribbon Score
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Was your MAP evaluated/assessed using other tools?
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Yes
No
If yes, provide a list of evaluation/assessment tools you used.
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Do you give PHO permission to share your Municipal Alcohol Policy externally for educational purposes on the Public Health Ontario website?
*