Forms
Table of Contents
- Activities Requiring Permits
- Agricultural Fairgrounds & Mass Gatherings
- Body Art
- Campgrounds
- Children's Camps
- Mobile Home Parks
- Public Food Service
- Public Swimming Pools & Bathing Beaches
- Temporary Residences (Hotels, Motels & Cabin Colonies) & Migrant Farm Worker Housing
- Water & Wastewater Utilities
- Plan Review & Approvals
- Complaints & Referrals
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)
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
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)
