FAIRFIELD DEPARTMENT OF HEALTH: DEPARTMENT FORMS
ENVIRONMENTAL HEALTH FORMS
NURSING FORMS
WIC PROGRAM APPLICATION + HEALTH HISTORY FORMS
SPANISH
WIC PROGRAM APPLICATION + HEALTH HISTORY FORMS
VITAL STATISTICS FORMS
• Nuisance Complaint Form
• Food Facility Review Packet
• Temporary Food Application Packet
• Mobile Food Application Packet
• Animal Bite Reporting Form
• Plumbing Forms
• Sewage Treatment Permit Application
• Variance Request Form
• Subdivision of Land / Lot Inspection Application
• Private Water System Application
• Well Pump Completion Form
• As-Built Packet
• Tattoo/ Body Piercing Facility Application
• STS Abandonment Form
NURSING FORMS
• TDAP & Menigitis Registration Forms for 7th & 12 grade
• ODH Reportable Disease Form
• ABC's of Reportable Diseases
• Adult Travel Paperwork / Child Travel Paperwork
• Immunization Clinic Form
WIC PROGRAM APPLICATION + HEALTH HISTORY FORMS
• Welcome to WIC
• WIC Program Application /
History Forms: Pregnant Woman, Breastfeeding & Postpartum Woman,
Infants under 12 months, Children 1-5 years
• WIC Authorized Letter
SPANISHWIC PROGRAM APPLICATION + HEALTH HISTORY FORMS