Crisis Care Facility (C.C.F.) Licence Application Form

Facility Information

Property Information

Applicant Information

Local Contact (available within 1 hour)

Required Document Uploads

1) Owner Authorization

Signed authorization from all legal owners of the property where the C.C.F. is/will be located, confirming awareness, consent, and authorization for the intended Crisis Care Facility use. If leased, include lease language permitting the C.C.F. use.

Suggested file name: Owner_Authorization_CCF.pdf

2) Operational Plan (By-law Compliance & Community Management)

A consolidated plan describing how the operator will comply with Town by-laws and applicable law and engage/mitigate impacts in the surrounding community, per the by-law.

• CPTED assessment: lighting, natural surveillance, access control, video surveillance, landscaping.
• Community engagement strategy: communication channels, meetings cadence, issue resolution steps.
• Security program (24/7): on-site and mobile coverage; incident response on the property and within the surrounding 500 m radius.
• Lot maintenance plan: bin locations, waste storage areas, service frequency; litter abatement on-site and within the surrounding 500 m radius.
• Designated outdoor smoking area compliance (Durham Region Smoking & Vaping By-law; Smoke-Free Ontario Act).
• Parking plan: staff/volunteers/suppliers/visitors; on-street/on-site restrictions; accessible parking.
• Donation management plan: proactive measures to limit/manage unsolicited donations to patrons.
• Code of Conduct: summary of expectations, enforcement approach, and provision to occupants.

Suggested file name: Operational_Plan_CCF.pdf

3) Floor Plan & Site Plan (Interior & Exterior Requirements)

Upload both the Floor Plan and the Site Plan showing the minimum details specified in the by-law.

• Floor Plan: all exits, windows, all rooms with labels indicating sleeping quarters, and all common areas.
• Site Plan: location/number of parking spaces, garbage/waste storage areas, designated smoking areas, enclosures, accessory buildings, and fences.

Suggested file names: Floor_Plan_CCF.pdf and Site_Plan_CCF.pdf

4) Occupancy Report (Template & Reporting Commitment)

Provide your report template and a signed statement committing to provide occupancy reports as required by the Manager.

• Template fields: number of staff, number of occupants, and remaining available spaces.
• Include reporting cadence (daily/weekly), responsible contact person, and submission method.

Suggested file name: Occupancy_Report_Template.pdf

5) Insurance Certificate (Town of Ajax as Additional Insured)

Insurance certificate specific to C.C.F. use with a minimum $2,000,000 liability per occurrence, naming the Town of Ajax as additional insured, including endorsement for 15 days’ notice of cancellation/material variation.

Suggested file name: Insurance_Certificate_CCF.pdf

6) Valid Criminal Record Check of Applicant

Upload a current Criminal Record Check for the Applicant. Note: the Manager may refuse issuance where certain convictions exist (Parts V, VIII, IX of the Criminal Code without pardon), and may consider other convictions at discretion.

Suggested file name: Criminal_Record_Check_Applicant.pdf

Applicant Acknowledgements & Declaration

Personal Information Notice: Personal information contained on this form is collected under the authority of the Municipal Act and will be used for the consideration and/or approval of a Crisis Care Facility Exemption Request. Questions about this collection should be directed to the Records & Freedom of Information Coordinator at 65 Harwood Avenue South, Ajax, Ontario, L1S 2H9. (905) 619-2529 ext. 3343.