Public Health, Sanitation and Safety Program
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| Form # |
Form Name/Title |
Linked File |
Instruction/ Comments |
| CB-2 |
Fatal/Serious Accident Report
(Updated July 11th, 2024) |
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| CB-11 |
Application For Certificate of Approval To Operate a Youth Camp
(Updated March 15th, 2023) |
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Click here to pay online
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| CB-11A |
Youth Camp Supplemental Information Form
(Updated February 7th, 2024) |
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| CB-14 |
Application For Certificate of Approval To Operate a Single Sport Youth Camp
(Updated March 15th, 2023) |
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Click here to pay online
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| CB-14A |
Youth Camp Supplemental Information Form
(Updated February 7th, 2024) |
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| CB-15 |
Annual Accident Report Youth Camp Safety Act |
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| CB-17 |
Youth Camp Self-Inspection Report (for Youth Camp Operators) |
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| CB-18 |
Youth Camp Safety Detailed Data Sheet (for Local Health Inspectors) |
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| CB-19 |
Youth Camp Safety Detailed Data Sheet (for Youth Camp Operators) |
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| CB-20 |
Certification for the Replacement of Main Drain Covers in Pool/Spa |
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| CEOH-1 |
Checklist for Public Recreational Bathing Facilities (Updated Jan 17) |
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| PHSS-1 |
Application for Tanning Facilities Registration
(Updated August, 2016) |
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| PHSS-3 |
Tanning Facility Inspection Checklist
(Updated August, 2016) |
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| PHSS-4 |
Signature Page, Acknowledging Receipt of Grant Agreement for Special Health Projects |
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Instructions for Completing the PHSS-5 Payment Voucher (pdf 9k)
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| PHSS-6 |
Confidential Medical Waste Exposure Report |
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Body Art
For Local Health Officials Only
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| Form # |
Form Name/Title |
Linked File |
Instruction/ Comments |
| CES-36 |
Body Art or Ear-Piercing Establishment Report of Infection or Injury
For Use by Local Health Department Officials only
(Previously EHS-36)
(Updated September 9th, 2022) |
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| EHS-34 |
Application for Approval to Operate a Body Art Establishment (Permanent) For use by Local Health Department Officials only. |
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| EHS-35 |
Application for Approval to Operate a Body Art Establishment (Temporary) For use by Local Health Department Officials only. |
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| EHS-47 |
Inspection Checklist For Body Art Facilities |
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