Thank you for protecting the health and safety of your workers and customers and being committed to our united fight against COVID-19. By submitting
this form, you are certifying that your business is complying with all health and safety standards. After completing this process, your business will be
added to the public listing of self-certified businesses, and you will receive branded material by mail to display at your business.
Before you fill out the information below, you must read and review the following health and safety guidelines:
HEALTH AND SAFETY REQUIREMENTS
*Choose a sector that closely aligns to your business
*Please specify your registered business name
*If you have multiple locations, you need to submit a form per location
*Please enter fire code Maximum Occupancy
Is this a Women-Owned Business (i.e. 51% or higher women ownership)?
Is this a MBE-Minority Business Enterprise (i.e. 51% or higher minority ownership)?
Is this a Veteran-Owned Business (i.e. 51% or higher veteran ownership)?
*Provide an active email address where you receive all business correspondence
*Please enter your email address
*Provide a phone number for your business communication in the format 1234567890
click on the link
to view the rules and guidelines to open and operate your business.
As a representative of this business, I understand that the most important consideration will be the health and safety of the employees and customers of my represented business. I have read these rules and will ensure strict adherence to the protocols listed.
I understand that if this business is found in violation of the requirements listed above, this certification may be revoked and this business may be removed from the public listing of self-certified businesses.
Provide the name of the owner or individual representing the business