Forms

Table of Contents

 

Forms

Agricultural Fairgrounds & Mass Gatherings

Application & Information for a Health Department "Permit to Operate" (Generic)

Body Art

EH-15-01: Application for a Permit to Operate a Body Art Establishment

EH-15-02: Application for a Certificate to Practice Body Art

EH-15-04: Body Art Risk Disclosure Statement & Consent Form

EH-15-05: Body Art Procedure Summary/Record

Body Art Code Booklet (SCCCHD Part 29)

Campgrounds

Application & Information for a Health Department "Permit to Operate" (Generic)

Children's Camps

Application & Information for a Health Department "Permit to Operate" (Generic)

NYSDOH Children's Camp Safety Plan Template

Appendix E: General Activity Worksheet

Appendix F: Sports

Appendix G: Swimming

Appendix H: Camp Trip Swimming

Appendix I: Boating

Appendix J: Archery

Appendix K: Riflery

Appendix L: Horseback Riding

Appendix M: Rope or Challenge Courses

Appendix N: Camp Trips

Appendix O: Spray Ground Facility Operation & Maintenance

Complaints & Referrals

Environmental Health Complaint/Referral Form (electronic version)

Environmental Health Complaint/Referral Form (paper version)

Mobile Home Parks

Application & Information for a Health Department "Permit to Operate" (Generic)

Onsite Water Supplies & Wastewater Treatment Systems

Application for an Onsite Wastewater Treatment System Construction Permit

Request for Inspection of Onsite Water Supply/Wastewater Utilities (for Real Property Transfers)

NYSDOH Coliform Bacteria in Drinking Water Supplies

Disinfection of Private Drinking Water Supplies

Septic System Operation & Maintenance Brochure

Sand Filter Maintenance Tips

Plan Review & Approvals

DOH-154: Notice of Intent to Construct, Enlarge, or Convert a Facility

CCHD Plan Review Fee Determination Schedule

Public Food Service

Application & Information for a Health Department "Permit to Operate" (FSE Specific)

Application for a Temporary Food Service Permit (TFSE Specific)

Temporary Food Service Information Packet

Additional Requirements for Food Service Establishments with Onsite Water & Wastewater Utilities

CCHD Application for Plan Review of Proposed/Renovated Food Service Establishment

Public Swimming Pools & Bathing Beaches

Application & Information for a Health Department "Permit to Operate" (Swimming Pool Specific)

Application & Information for a Health Department "Permit to Operate" (Bathing Beach Specific)

DOH-1323: Operation Report Form for Swimming Pools

DOH-4472: Swimming Pool Safety Plan Template

DOH-4473: Bathing Beach Safety Plan Template

Public Water Systems

DOH-360CUV: Water System Operation Report

Seasonal Startup Procedure for Public Water Supplies

Seasonal Startup Procedure Certification Form

Temporary Residences (Hotels, Motels & Cabin Colonies) & Migrant Farm Worker Housing

Application & Information for a Health Department "Permit to Operate" (Generic)

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