Forms & Permits

Accessibility

• Accessible Customer Service Request for Information and Communication (PDF)
• Accessible Customer Service Feedback Form (PDF)

Drinking water

• 4578 – 64E Lab services notification form
• 4579 – 64E SDWS identification form
• 4580 – 64E Notice of adverse test results/issue resolution form
• 012-1806 Well record request form

Educators

• Immunization Data Form (For Childcare Settings) (PDF)
• Pre-employment Health Assessment and Immunization for Child Care Staff (PDF)
• Child Care Order Form for Materials (PDF)
• Enteric Outbreak Line Listing (PDF)
• Community Food Advisor (CFA) request form (.doc)

Food, vendors, and special events

• Special Event Organizer Notification Form (PDF)
• Special Event Food Vendor Requirements/Application (PDF)
• Start Smart Package (PDF, 6 pages)
• Notice of Intent to Operate a Food Premises Form (.doc)
• Farmers' Market Food Vendor Application (PDF)

Healthy eating and physical activity

• Community Food Advisor (CFA) request form (.doc)
• Physical Activity Readiness Questionnaire (PAR-Q) (PDF)

Personal services settings (PSS)

Pregnancy and parenting

• Guelph General Hospital Obstetrical Preadmission Form (PDF)
• Nipissing District Developmental Screen

Travel

• Health History and Travel Itinerary (complete only after booking a travel health clinic appointment)

West Nile virus

• Backyard catch basin waiver form (PDF, mail completed form to our Fergus office)

Healthcare providers

• Reporting Mantoux TB Skin Test Form (PDF)
• Respiratory Outbreak Line Listing (PDF)
• Daily Outbreak Line Listing (Fax Cover Sheet) (PDF)
• Infectious Disease Incident Report for Emergency Services Workers (PDF)
• Rabies Exposure Report (PDF)