Massachusetts Health Officers Association
Youth Access to Tobacco Products

 
 
Tobacco Permit Applications
and Retail Employee Agreements
Permitting of tobacco vendors is an essential component in the reduction of youth access sales.  Along with a few examples of permit applications, this section contains a variety of forms that serve to educate permit holders and their employees regarding their responsibilities in tobacco sales.

 
Employee Agreement agreement-one.doc
Retail Employee Agreement agreemnet-two.doc
Board of Health Permit Application application-one.doc
Retail Owner/Operator Statement statement.doc
Application Information letter-one.doc
Tobacco Sales application-three.doc
Tobacco Permit application-two.doc
Letter to Permitted Vendor letter-two.doc
Department of Revenue Fact Sheet DOR_factsheet.doc

 
 
Merchant Education
 Merchant education visits to all tobacco vendors should be done at least twice annually.  During and after these visits you have the opportunity to provide the permit holder with valuable information that can be passed on to the retails employees to increase their awareness of tobacco issues, how to comply with regulations and how to accurately and effectively ascertain that each tobacco purchaser is at least 18 years old.  This section has been divided into sub-sections to give you examples of retail mailing, training information, and data sheets that you can use or adapt for merchant visits.

 
 
INCORPORATING RETAIL TOBACCO INSPECTIONS
 INTO OTHER INSPECTIONS
Retail Tobacco inspections can be easily incorporated into routine retail food inspections.  This power point presentation will show you what to look for, and how the tobacco inspection can be accomplished in less than 5 minutes.  Below is a quick checklist for conducting retail inspections.
Inspection Checlist

If you have any questions about retail inspections or other tobacco control issues please contact:  Sarah McColgan, MHOA Tobacco Control Director at 413-596-8967 or 


 
 
Merchant Education Flyers and Mailings
Ed Postcard-ID card-id.doc
Ed Postcard-Chew card-chew.doc
Ed Postcard-Cigars card-cigars.doc
Ed Postcard-Blunts card-blunts.doc
Ed Postacerd-Photo ID card-photo-id.doc
Merchant Ed Contact Record contact-record.doc
Ed Postcard-Compliance card-compliance.doc
Ed Postcard-Rolling Papers card-rolling-papers.doc
Ed Postcard-Under 21 License card-under-21-license.doc
Warning in Many Languages warning-many-languages.doc
Flyer on Acceptable Forms of ID flyer-acceptable-forms-of-id.doc

 
Retail Training for Vendors & Employees
Invitation Letter invitation-letter.doc
Training Flyer training-flyer.doc
Training Verification training-verification.doc

 
Retail Tobacco Inspections
Merchant Ed Visit Data merchant-visit-data.doc
Retail Inspection Report Sheet inspection-report.doc
Tobacco Complaint Form complaint-form.doc

 
Inspection Follow-up
Asked for Age, Not ID tcp-asked-age-not-id.doc
Merchant Ed Follow-Up tcp-merchant-ed-follow-up.doc

 
 
 
Compliance Check Consents
and Buyers' Agreements
In this section you will find helpful forms that should be given to youth who plan to participate in compliance checks either prior to or at the training that you provide for them.  Parents must consent to their participation in the compliance check for safety and liability purposes.  Youth should also sign an agreement to ensure that they understand the suggested protocols.  There is also a flyer to recruit youth to participate in these checks.
 
Help Wanted Flyer for Youth Compliance Agents tcp-help-wanted.doc
Introduction Letter to Parents of Compliance Cleck tcp-intro-letter.doc
Parent Consent and Buyer's Agreement tcp-parent-consent.doc
Parental Permission for Compliance Check tcp-permission.doc
Volunteer Form tcp-volunteer-form.doc

 
 
 
Compliance Check Forms
This section contains samples of forms for volunteers, stipend youth and independent contractors who participate in compliance checks.  There are also sample forms for data collection if there is a sale, disposal of tobacco products and documentation of expenses.
 
Compliance Check Cash Expense Form cash-expense-form.doc
Compliance Check Stipend Sheet stipend-sheet.doc
If Sale Occurred Data Sheet if-sale-occurred.doc
Contractor's Form contractors-form.doc
Tobacco Evidence Disposal Sheet evidence-disposal.doc

 
 
 
Tickets, Violation Notices and Suspensions
There are many types of ticket forms that you can use.  Some municipalities use tickets that are specific to tobacco violations and some use generic tickets that can be used by many departments.  Below are some sample tickets.  There are also a number of ways to notify a violator that a sale has taken place, a permit has been suspended, and to notify the public that a store is under suspension.  A sample of these forms also follows.  Tracking sales, fine payments, hearings and suspensions is vital to accurate record keeping.  Below is a sample tracking form.  Please feel free to adapt these forms to fit your needs.

 
Notice of Hearing Results tcp-hearing-results.doc
Notification of Sale Letter - 2nd Sale tcp-second-sale.doc
Permit Suspension Sign One tcp-sign-one.doc
Permit Suspension Sign Two tcp-sign-two.doc
Sale, Fine, Hearing, Suspension Track tcp-tracking.doc
Boston Violation Ticket tcp-boston-ticket.dot
Training as Option to Paying Fine tcp-training-option.doc
Violation Letter tcp-violation-letter-two.doc
Sale to Minor Supporting Affidavit tcp-supporting-affidavit.doc
Violation Letter Third Sale tcp-violation-third-sale.doc
Warning Letter of non Paymenht of Ticket tcp-warning-letter.doc

 
 
 
Court
Whether you are going to court for a Youth Access Violation or a Violation of the Smoke Free Workplace Law, you should be well prepared.  You may want or need the assistance of your Town Counsel.

Housing Court tcp-housing-court.doc

Other resources include:
1. Cheryl Sbarra, Esquire, Mass Association of Health Boards.
She can be reached at 

2. D.J. Wilson, Esquire, Mass Municipal Association.
He can be reached at