Portage County Health District

Frequently Requested Forms


Food Related Forms

2019 Ohio Uniform Food Saftey Code
Application for a Temporary Food Service Operation (Fillable PDF)
Application for a Food Service Operation or Retail Food Establishment (Plan Review Application)
Employee Health Policy Agreement with COVID-19
Time/Temperature Control for Saftey (TCS) Foods 

Responding to Vominting/Diarrheal Incident 

Campground Related Forms

Temporary Plan Review License
Pool Related Forms

Ohio Department of Health Swimming Pools and Spas 

Equipment Replacement
Plumbing Forms
Clearwater Permit Application
New Plumbing Contractor Application 2020-2021
Ohio Licensed Plumbing Contractor Registration
Home Owner Affidavit
Residential Plumbing Permit Application
Commercial Plumbing Permit Application
Private Water Testing

Bacterial/Chemical Water Testing Request Form 

Sampling Fees 
Nuisance (Environmental Complaint) Related Forms

Environmental Nuisance Complaint

Waste Water Related Forms

2020 Wastewater Pollution Control Loan Fund (WPCLF) Application 


2020 Wastewater Pollution Control Loan Fund (WPCLF) Sanitary Sewer Connection Application

Application for Sewage Treatment System Site Evaluation New + Replacement

Evaluation Application for House Sale/Refinance for a Vacant House

Evaluation Application for House Sale/Refinance for a Occupied House

Sewage Treatment System (STS) Abandonment Application

Septage Pumping Report Form

Ohio Department of Health Sewage Treatment System Program

Animal Bites
Animal Bite Report Form

Animal Bite Report Form - fillable

Nursing - Back To School Immunization Clinics
Consent Form

Letter to Parents

HIPPA Policy
Ohio Required School Vaccinations
Hepatitis A Vaccine Information
Hepatitis B Vaccine Information
HPV Vaccine Information
Mengingococcal ACWY Vaccine Information
Polio Vaccine Information
TDaP Vaccine Information
Varicella (Chickenpox) Vaccine Information