Local Health Department Forms, Documents and Administrative Reference Main ContentAdministrative Reference Local Health Department Administrative Reference Document Administrative Reference Documents Download Aging Report - Sample (Financial Management) Appointment of Local Registrar and Deputy Birth-Death Index Form HD Collaborative Agreement for Advanced Practice Registered Nurse (Local Health Personnel) Declination of Hepatitis B Vaccine (OSHA Bloodborne Pathogens) Environmental Fee Revenue Procedures (Environmental Health) Environmental Write-Off Form (Environmental Health) Facility Lockdown Procedural Guidelines - Template (Preparing And Responding to Bioterrorism) Family Planning Expanded Role Registered Nurse Collaboration of Agreement Sample (Local Health Personnel) Food Safety Branch Vehicle Incident Report Reporting Form (Environmental Health) Food Safety Branch Vehicle Incident Report Instructions (Environmental Health) Human Trafficking Screening Questions (Abuse, Neglect, Violence) Incident/Complaint Report Form (Incident Reports) Laboratory Incident Form (Incident Reports) Lead Warning Poison Notice (Environmental Health) Local Health Department Employee Privacy and Security of Protected Health, Confidential and Sensitive Information Agreement (Local Health Personnel) Local Health Department Exposure Control Plan - Template (OSHA Bloodborne Pathogens) Local Health Department Internal Controls Program Guidelines (Financial Management) Maternal And Child Health Coordination - Function Codes Medication Plan for Local Health Departments - Sample (Medical Records Management) Next Relative ContentClinical Service GuideClinical Service Guide Forms and Teaching SheetsLocal Health Department Information Page Select a category All Clinic Health Environmental Health LHD Security Request All DownloadLHD Document Types DFS-215 Application for ReinstatementEnvironmental Health DFS-222 Notice and Order of Quarantine/Voluntary DestructionEnvironmental Health DFS-232 Permit to OperateEnvironmental Health DFS-253 Ear Piercing Studio Inspection ReportEnvironmental Health DFS-303 Application for Certification/RegistrationEnvironmental Health DFS-306 Application for a Permit/License Environmental Health DFS-308 Youth Camp Inspection ReportEnvironmental Health DFS-309 Youth Camp Accident/Illness ReportEnvironmental Health DFS-317 Application for a PermitEnvironmental Health DFS-319 Onsite Sewage Disposal Systems Application for Site EvaluationEnvironmental Health DFS-325 Request for Onsite Sewage Disposal System VarianceEnvironmental Health DFS-326 Existing Sewage System and Owner's AffidavitEnvironmental Health DFS-327 Request for Service RecordEnvironmental Health DFS-334 Alternative/Experimental Onsite Sewage Disposal SystemEnvironmental Health DFS-335 Business License Surety BondEnvironmental Health DFS-336 Affidavit of Surety's QualificationsEnvironmental Health DFS-340 Application and Permit to Operate Day Camp FacilitiesEnvironmental Health DFS-345 Application for Site Evaluation and Permit to Operate a Disposal SiteEnvironmental Health DFS-400 Tanning Facility Registration/MonitorEnvironmental Health DFS-405 Onsite Sewage Agency Referral FormEnvironmental Health Enviro Shelter Surveillance FormEnvironmental Health LHO-001 PSRS/BRIDGE Security RequestLHD Security Request LHO-002 CMS PORTAL Security RequestLHD Security Request LHO-003 EHMIS/PORTAL Security RequestLHD Security Request LHO-004 CDP eReports Security RequestLHD Security Request LHO-005 L-Drive Security Request (LHDs only)LHD Security Request LHO-006 Global Email Distribution Request FormLHD Security Request LHO-007 Splash-BI Tool Security RequestLHD Security Request WIC-001 CDP WIC eReports Security RequestLHD Security Request Previous Contact Information