Forms

get_adobe_reader*Note: In order to view and print these documents, your computer must have the Adobe Acrobat Reader utility installed; if this software is not installed on your system, you can download it for free from Adobe.


Download the Record of Complaint & Results of Investigation

*Note: In order to view and print this form, your computer must have the Adobe Acrobat Reader utility installed; if this software is not installed on your system, you can download it for free from Adobe.This form is in a read-only format. Provided you have Adobe Acrobat Reader 4.0 or better, it can be filled out on your computer and printed for mailing. Your work cannot be saved, however.

Instructions for submitting application:

This completed form provides details on the location (restaurant, house, alley, residential area, etc…) and the specific nature of an environmental health complaint.

If you are not sure about something on the application simply call our office and we will be more than happy to assist you.

Submit Application With Appropriate Materials To:

Environmental Health
Richmond City Health District
400 East Cary Street
Richmond, VA 23219
Fax: 804-371-2208


Download the Coordinator’s Application for a Temporary Event

*Note: In order to view and print this form, your computer must have the Adobe Acrobat Reader utility installed; if this software is not installed on your system, you can download it for free from Adobe. This form is in a read-only format. Provided you have Adobe Acrobat Reader 4.0 or better, it can be filled out on your computer and printed for mailing. Your work cannot be saved, however.

Instructions for submitting application

RCHD requests that the form be filled out by the event sponsor listing all food booth participants, and the time and date of special events. Please submit no later than 10 days prior to the event.

If you are not sure about something on the application simply call our office and we will be more than happy to assist you.

Submit Application With Appropriate Materials To:

Environmental Health
Richmond City Health District
400 East Cary Street
Richmond, VA 23219
Fax: (804) 371-2208


Download the Application for a Temporary Health Permit

*Note: In order to view and print this form, your computer must have the Adobe Acrobat Reader utility installed; if this software is not installed on your system, you can download it for free from Adobe. This form is in a read-only format. Provided you have Adobe Acrobat Reader 4.0 or better, it can be filled out on your computer and printed for mailing. Your work cannot be saved, however.

Instructions for submitting application:

Special event participants who wish to serve food must use this form to list all food and beverages to be served. This application should be submitted 10 days prior to the event.

If you are not sure about something on the application simply call our office and we will be more than happy to assist you.

Submit Application With Appropriate Materials To:

Environmental Health
Richmond City Health District
400 East Cary Street
Richmond, VA 23219
Fax: (804) 371-2208


Download the Application for a Death Certificate

*Note: In order to view and print this form, your computer must have the Adobe Acrobat Reader utility installed; if this software is not installed on your system, you can download it for free from Adobe. This form is in a read-only format. Provided you have Adobe Acrobat Reader 4.0 or better, it can be filled out on your computer and printed for mailing. Your work cannot be saved, however.

Instructions for submitting application

To request a copy of a death certificate, please submit this application along with $12.00 per copy. Copies may be obtained by an immediate member of the family or designated appointee. Please include a return address and telephone number when applying for a record, and allow 3 days for delivery of your record by mail.

If you are not sure about something on the application simply call our office and we will be more than happy to assist you.

Submit Application With Appropriate Materials To:

Vital Records
Richmond City Health District
400 East Cary Street
Richmond, VA 23219


Download the Application for Food Establishment Permit

*Note: In order to view and print this form, your computer must have the Adobe Acrobat Reader utility installed; if this software is not installed on your system, you can download it for free from Adobe. This form is in a read-only format. Provided you have Adobe Acrobat Reader 4.0 or better, it can be filled out on your computer and printed for mailing. Your work cannot be saved, however.

Instructions for submitting application

This application is used to request to operate a restaurant, daycare center, adult home, school, or is to be used if ownership is changing at any of the above locations. Applications are usually processed within 7– 10 days. Please note – the Commissary Form Page is for Mobile Food Unit.

If you are not sure about something on the application simply call our office and we will be more than happy to assist you.

Submit Application With Appropriate Materials To:

Environmental Health
Richmond City Health District
400 East Cary Street
Richmond, VA 23219


Download the RCHD Mobile Food Unit Plan Review Guidelines and Application:

Instructions for submitting application:

This Mobile Unit Plan Review Guidelines and Application is used in conjunction with the Application for Food Establishment Permit, to request to operate a mobile food unit, mobile push cart or vending truck or is to be used if ownership is changing or unit has been sold. Applications are usually processed within 7-10 business days once all required paperwork has been submitted.

If you are not sure about something on the application simply call our office and we will be more than happy to assist you.  Please see the RCHD Mobile Food Unit Guidelines document for more information.

Submit application with appropriate materials to:

Environmental Health
Richmond City Health District
400 East Cary Street
Richmond, VA 23219

Download the RCHD Mobile Food Unit Guidelines document:

This document is intended as a guide to assist potential owners and operators of mobile food establishments in meeting the requirements of the Commonwealth of Virginia Board of Health Food Regulations 12 VAC 5-421.  It is designed to be a companion document to the RCHD MOBILE FOOD UNIT PLAN REVIEW packet and pertains to potential owners and operators of mobile food establishments (mobile food unit, mobile pushcart, vending truck). This material does NOT contain all of the health rules and regulations, but rather provides guidance on obtaining an operating permit and lists most of the basic requirements. These regulations are available at the following website: http://www.vdh.virginia.gov/environmental-health/food-restaurant-safety/food-safety-in-virginia/food-regulations

Thorough review of this information and guidance may help expedite the processing of the food service permit application.


Download the Plan Review Form

Instructions for submitting the Plan Review Form: This Plan Review Form is used in conjunction with the Application for Food Establishment Permit to request to operate a food establishment that is being built, renovated or where equipment is added or changed.  Plan Review may also be requested for existing food establishments making major renovations.  Please submit a set of plans, manufacturer equipment specification sheets for all equipment and the Plan Review Form.  The purpose for the review and approval of plans prior to any work being done is to ensure compliance with The Commonwealth of Virginia Board of Health Food Regulations and to prevent misunderstanding by the operator as to what is required.  Plan review gives the Environmental Health Department the opportunity to evaluate and provide feedback to the operator for design and construction.

Applications are usually processed within 7-10 business days days once all required paperwork has been submitted.

If you are not sure about something on the application simply call our office and we will be more than happy to assist you.

Submit application with appropriate materials to:

Environmental Health
Richmond City Health District
400 East Cary Street
Richmond, VA 23219