Public Health, Sanitation and Safety Program
|
| Form # |
Title |
PDF/WORD |
Instruction/ Comments |
| CB-2 |
Fatal/Serious Accident Report |
pdf 23k
doc 99k |
|
| CB-11 |
Application for Certificate of Approval to Operate a Youth Camp (The form for the current camp season is available from March 1 through August 31.) |
|
|
| CB-14 |
Application for Certificate of Approval to Operate a Youth Camp -Single Sport Youth Camp (SSYC) |
|
|
| CB-15 |
Annual Accident Report Youth Camp Safety Act |
pdf 13k
doc 67k |
Instructions and Codes for Annual Accident Report
pdf 10k
doc 24k
|
| CB-17 |
Youth Camp Self-Inspection Report (for Youth Camp Operators) |
pdf 23k
doc 129k |
|
| CB-18 |
Youth Camp Safety Detailed Data Sheet (for Local Health Inspectors) |
pdf 69k
doc 211k |
|
| CB-19 |
Youth Camp Safety Detailed Data Sheet (for Youth Camp Operators) |
pdf 73k
doc 312k |
|
| CB-20 |
Certification for the Replacement of Main Drain Covers in Pool/Spa |
pdf 20k
doc 55k |
|
| EHS-11 |
Inspection of Bathing Beaches |
pdf 20k
doc 62k |
|
| EHS-12 |
Inspection of Hot Tubs/Spas |
pdf 24k
doc 66k |
|
| EHS-13 |
Inspection of Swimming Pools |
pdf 30k
doc 94k |
|
| EHS-14 |
Inspection of Swimming Pools, Hot Tubs and Spas |
pdf 36k
doc 120k |
|
| PHSS-1 |
Application for Tanning Facilities Registration |
|
|
| PHSS-2 |
Warning Statement and Tanning Authorization |
pdf 27k
doc 36k |
|
| PHSS-3 |
Tanning Facility Inspection Checklist |
pdf 31k
doc 56k |
|
| PHSS-4 |
Signature Page, Acknowledging Receipt of Grant Agreement for Special Health Projects |
pdf 9k
doc 29k |
|
| PHSS-5 |
Payment Voucher, Tanning Facility Inspections |
pdf 37k
doc 60k |
Instructions for Completing the PHSS-5
pdf 9k
doc 24k
|
Body Art
For Local Health Officials Only
|
| Form # |
Title |
PDF/WORD |
Instruction/ Comments |
| EHS-34 |
Application for Approval to Operate a Body Art Establishment (Permanent) For use by Local Health Department Officials only. |
pdf 17k
doc 72k |
|
| EHS-35 |
Application for Approval to Operate a Body Art Establishment (Temporary) For use by Local Health Department Officials only. |
pdf 16k
doc 60k |
|
| EHS-36 |
Body Art Infection/Injury Report For use by Local Health Department Officials only. |
pdf 24k
doc 90k |
|
DHSS Forms
