Nursing/Clinic Forms

Administrative

Public Participation Form (Submit form to one of these options  email: stephanie.bragg@morrowcountyhealth.org, fax: 419-946-6807 or bring form into office)
Public Records Request
Blank IRS W-9 Form
Morrow County Health District W-9 Form

Vital Records

Birth/Death Certificate Application
Proof of Relationship Verification Form

Clinic Forms

Registration Consent
Flu
Privacy Practice Acknowledgement
Screening and Consent
Prior Authorization 
School Vaccine Clinic Consent Form

Environmental Health

Food

FSO/RFE License for Food Service Application
Mobile Food License Application
Temporary Food License Application

Plumbing

License Bond
Plumber Application
Registered Plumbers

 

 

Parks and Campground

Campground Application
Resident Camp Application
Temporary Camp Application

 

 

 

Sewage

New Build Process Form
New Lot – Site Review Form
Soil Scientists
System Designers
Septic Permit
Registered Sewage Sys. Inspectors for Existing Systems (Non-Mechanical)
Registered Sewage Sys. Inspectors for Existing Systems (Aeration)
Registered Sewage System Installers
Registered Sewage System Pumpers

 

 

 

 

 

 

 

 

 

Swimming Pools and Beaches

Beach Application
Swimming Pool Application
Pool Plan Review Application

 

 

Water

Water Sample
Well Permit
Job Status Completion Form

 

 

 

Registered Service Provider

Contact Information
STS Contractor Fact Sheet
Service Provider Application
Service Provider Bond Form
Sewage System Non-Mechanical Inspection Form
Sewage System Aeration Inspection Form

Registered Hauler

Contact Information
STS Contractor Fact Sheet
Hauler Application
Hauler Bond Form

 

 

Registered Installer

Contact Information
STS Contractor Fact Sheet
Installer Application
Installer Bond Multi-System Form
As-Built Form

 

 

 

Miscellaneous

Variance Application
Animal Exposure Form
Nuisance Complaint Form

 

 

Accessibility