DOH Forms
Additional Health Department Forms

Forms for Food & Drug Safety Program


Forms and Instructions
Form # Title PDF/WORD Instruction/ Comments
F-2 Registration of Drug or Medical Device Manufacturing or Wholesale Drug or Medical Device Business pdf 68k
doc 402k
 
F-5 Initial Application for Certification to Sell Bottled Water or Bulk Water pdf 18k
doc 79k
 
F-8 Initial Application for License to Operate a Refrigerated Warehouse and/or Locker Plant pdf 14k
doc 33k
 
F-9 Initial Application for License to Operate a Non-Alcoholic Beverage Manufacturing Plant pdf 12k
doc 33k
 
F-12 Application for Certificate of Free Sale (CFS) pdf 18k
doc 41k
 
F-13 Renewal or Discontinuation of Application to Operate a Wholesale Drug or Medical Device Business pdf 23k
doc 71k
 
F-17 Application for Permit to Handle Nitrous Oxide pdf 13k
doc 34k
 
F-19 Renewal Application to Operate a Refrigerated Warehouse-Locker Plant pdf 15k
doc 41k
 
F-26 Self-Inspection Checklist (Wholesale) pdf 23k
doc 86k
 
F-27 Self-Inspection Checklist (Retail) pdf 21k
doc 74k
 
F-29 Initial Application for License to Operate a Wholesale Food-Cosmetic Establishment pdf 30k
doc 66k
 
F-30 Satisfactory Placard pdf 26k
doc 246k
Note  
F-31 Unsatisfactory Placard pdf 26k
doc 245k
Note  
F-32 Conditionally Satisfactory Placard pdf 26k
doc 26k
Note  
F-33 Sanitary Inspection Report pdf 22k
doc 253k
Note  
F-35 Retail Food Inspection Report (Local Health Departments) pdf 33k
doc 112k
Note  
F-37 Risk-Based Inspection Report (Local Health Departments) pdf 27k
doc 115k
Note  
F-39 Renewal Application to Operate a Non-Alcoholic Beverage and/or Bottling Plant pdf 15k
doc 41k
 
F-41 Renewal Application to Operate a Wholesale Food/Cosmetic Establishment pdf 15k
doc 43k
 
F-42 Renewal Application for Certification to Sell Bottled Water or Bulk Water pdf 21k
doc 87k
 
F-48 Application for Certification to Handle Oysters, Clams or Mussels pdf 13k
doc 38k
 
F-L3 Certificate of Free Sale Package (English) (including F-L3 and F-12 Forms) pdf 32k
doc 766k
Guidelines for Requesting Certificates of Free Sale  
F-L4 Certificate of Free Sale Package (Spanish) (including F-L4 and F-12 Forms) pdf 32k
doc 767k
Guidelines for Requesting Certificates of Free Sale  
M-3 Initial Application for a Milk Plant or a Bulk Milk Hauler Permit pdf 22k
doc 64k
 
M-5 Initial Application for License to Manufacture Frozen Desserts pdf 15k
doc 38k
 
M-6 Renewal Application to Operate a Frozen Dessert Plant pdf 16k
doc 16kk
 
M-8 Renewal Application to Operate a Bulk Tank Unit/Milk Plant pdf 15k
doc 43k
 
MS-5 Continuation Sheet pdf 10k
doc 36k
 

Wholesale Food/Cosmetic Establishments
Form # Title PDF/WORD Instruction/ Comments
F-29 Initial Application for License to Operate a Wholesale Food-Cosmetic Establishment pdf 30k
doc 66k
 
F-41 Renewal Application to Operate a Wholesale Food/Cosmetic Establishment pdf 15k
doc 43k
 

Milk Plants/Bulk Milk Hauler
Form # Title PDF/WORD Instruction/ Comments
M-3 Initial Application for a Milk Plant or a Bulk Milk Hauler Permit pdf 22k
doc 64k
 
M-8 Renewal Application to Operate a Bulk Tank Unit/Milk Plant pdf 15k
doc 43k
 

Frozen Dessert Plants
Form # Title PDF/WORD Instruction/ Comments
M-5 Initial Application for License to Manufacture Frozen Desserts pdf 15k
doc 38k
 
M-6 Renewal Application to Operate a Frozen Dessert Plant pdf 16k
doc 16kk
 

Bottled Water Registration
Form # Title PDF/WORD Instruction/ Comments
F-5 Initial Application for Certification to Sell Bottled Water or Bulk Water pdf 18k
doc 79k
 
F-42 Renewal Application for Certification to Sell Bottled Water or Bulk Water pdf 21k
doc 87k
 

Shellfish Certification
Form # Title PDF/WORD Instruction/ Comments
F-48 Application for Certification to Handle Oysters, Clams or Mussels pdf 13k
doc 38k
 

Non Alcoholic Beverage Establishments
Form # Title PDF/WORD Instruction/ Comments
F-9 Initial Application for License to Operate a Non-Alcoholic Beverage Manufacturing Plant pdf 12k
doc 33k
 
F-39 Renewal Application to Operate a Non-Alcoholic Beverage and/or Bottling Plant pdf 15k
doc 41k
 

Refrigerated Warehouse
Form # Title PDF/WORD Instruction/ Comments
F-8 Initial Application for License to Operate a Refrigerated Warehouse and/or Locker Plant pdf 14k
doc 33k
 
F-19 Renewal Application to Operate a Refrigerated Warehouse-Locker Plant pdf 15k
doc 41k
 
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