Clean Indoor Air Act Forms 


To download the forms linked below, please right click and select "Save Target As" then select the location "Save in your Desktop." Then close your browser and open the file from your desktop to complete and mail your form. Please save your form upon completion for your own files.

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• Clean Indoor Air, Application for Exception for Cigar Bar, Drinking Establishment or Tobacco Shop - Use this form to apply for a smoking exception. CIAA Application Guidance Document 
  • To submit electronically
  • To submit by hard copy
• Event Exception Form - Use this form to notify the Department of Health of a fundraiser or facility at which smoking will occur.
  • To submit electronically
  • To submit by hard copy 
• Private Club Reporting Form - Use this form to report the result of a vote of a private club to allow smoking.
  • To submit electronically
  • To submit by hard copy 
• Renewal Instructions and Forms - Use these forms to submit sales information in order to renew your smoking exception.
• Person to Person Transfer Form - Use this form to notify the Department of Health that you are the new owner of a business with a smoking exception/a liquor license transfer has occurred.

   
Do you need help completing these forms?  Contact your Regional Primary Contractor for your county or call (717) 783-6600.