All applications and forms are to be turned in to your local health department. Contact your local health department with questions regarding these applications and forms. The Chickahominy Health District accepts cash, checks and VISA for fees associated with applications.
Food Service Applications, Forms, & Regulations |
|
| Name: | Description: |
| Food Establishment Application | Application for a Virginia Department of Health Food Establishment Permit |
| Foodservice Plan Review | Plans to review for approval before food establishment permit |
| FDA Food Establishment Plan Review Guide | Food and Drug Administration’s guide to assist food establishments in foodservice plan reviews. |
| Temporary Food Establishment Application
*These forms can be emailed to Chickahominy.EHSS@vdh.virginia.gov if $40 fee has been previously paid within the past calendar year. |
Application for a temporary food establishment. Temporary event applications must be submitted 10 business days prior to an event |
| Virginia Food Regulations | |
| FDA Federal Food Code Document | Food and Drug Administration’s guide to ensure food and public health safety from food establishments |
| Mobile Food Unit Application | Application for a Department of Health Mobile Food Unit Permit |
Septic System Repair Malfunction Assessment and Instructions |
|
| Name: | Description: |
| Chickahominy Health District Septic System Repair History Questionnaire and Instructions *This form can be emailed to Chickahominy.EHSS@vdh.virginia.gov |
Septic system repair instructions and repair history questionnaire |
| Malfunction Assessment | |
| Septic System Repair Instructions | |
| Freedom of Information Request Form | Form to request documents or other information under the Freedom of Information Act |
| VDH Septic System & Well Construction Permit Process | Information regarding hiring a private sector for construction permit process for wells or septic systems |
| Septic System and/or Private Well Application | Only owners that submit a petition for services and meet i) means testing requirements (household income does not exceed 100% of federal poverty guidelines), or ii) a hardship contained in the Virginia Department of Health’s Hardship Guidelines, will be eligible to receive evaluation and design services from the Virginia Department of Health. |
Other Applications, Forms, & Regulations |
|
| Name: | Description: |
| Hotel Application | Application for a Department of Health Tourist Establishment/Campground/Summer Camp Permit |
| Summer Camp Application | Application for a Department of Health Summer Camp Permit |
| Campground Application | Applications for a Department of Health Campground Permit and Plan Review |
| Tourist Establishment Regulation | |
| Migrant Labor Camp Application | Application for a Migrant Labor Camp Permit |
Epidemiology Forms |
|
| Name: | Description: |
| EPI 1 Form PDF | Form to report disease cases to your local health department. |
| Electronic Morbidity Reporting Portal EPI1 | EPI1 Portal Instructions |
| Electronic Morbidity Reporting Portal (EPI1) | EPI1 Portal |
These documents are currently being remediated for accessibility. If you need assistance, please reach out to chdwellness@vdh.virginia.govH