{"id":32,"date":"2017-02-09T19:51:57","date_gmt":"2017-02-09T19:51:57","guid":{"rendered":"https:\/\/www.vdh.virginia.gov\/chickahominy\/?page_id=32"},"modified":"2026-05-05T13:24:07","modified_gmt":"2026-05-05T17:24:07","slug":"forms-applications","status":"publish","type":"page","link":"https:\/\/www.vdh.virginia.gov\/chickahominy\/forms-applications\/","title":{"rendered":"Forms, Applications and Regulations"},"content":{"rendered":"

All applications and forms are to be turned in to your local health department. Contact your local health department with questions regarding these applications and forms. The Chickahominy Health District accepts cash, checks and VISA for fees associated with applications.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n
\n

Food Service Applications, Forms, and Regulations<\/b><\/h2>\n<\/td>\n<\/tr>\n

\n

Name:<\/b><\/span><\/h3>\n<\/td>\n

\n

Description:<\/b><\/span><\/h3>\n<\/td>\n<\/tr>\n

Foodservice Establishment Permit<\/a><\/strong><\/td>\nApplication for a Department of Health Food Establishment Permit<\/td>\n<\/tr>\n
Foodservice Plan Review<\/a><\/strong><\/td>\nPlans to review for approval before food establishment permit<\/td>\n<\/tr>\n
FDA Food Establishment Plan Review Guide<\/a><\/strong><\/td>\nFood and Drug Administration\u2019s guide to assist food establishments in foodservice plan reviews.<\/td>\n<\/tr>\n
Temporary food Establishment Permit Application<\/a><\/strong><\/p>\n

Event Coordinator Application<\/a><\/strong><\/p>\n

*These forms can be emailed to Chickahominy.EHSS@vdh.virginia.gov<\/a> if $40 fee has been previously paid within the past calendar year.<\/td>\n

Application for a temporary food establishment. Temporary event applications must be submitted 10 business days prior to an event<\/td>\n<\/tr>\n
Virginia Food Regulations<\/a><\/strong><\/td>\n<\/td>\n<\/tr>\n
FDA Federal Food Code Document<\/a><\/strong><\/td>\nFood and Drug Administration\u2019s guide to ensure food and public health safety from food establishments. Updated in 2017.<\/td>\n<\/tr>\n
Mobile Food Unit Plan Review Application<\/a><\/strong><\/td>\nApplication requesting a review and approval of plans prior to new construction or remodeling of mobile unit.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n\n\n\n
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Septic System Repair Malfunction Assessment and Instructions<\/strong><\/h2>\n<\/td>\n<\/tr>\n

\n

Name:<\/b><\/span><\/h3>\n<\/td>\n

\n

Description:<\/b><\/span><\/h3>\n<\/td>\n<\/tr>\n

Condition Assessment<\/a><\/strong><\/td>\nForm used by Onsite Soil Evaluators to document and describe the condition of an existing septic system and its components.<\/span><\/td>\n<\/tr>\n
Freedom of Information Request Form<\/a><\/strong><\/td>\nForm to request documents or other information under the Freedom of Information Act.<\/td>\n<\/tr>\n
VDH Septic System & Well Construction Permit Process<\/a><\/strong><\/td>\nInformation regarding hiring a private sector for construction permit process for wells or septic systems.<\/td>\n<\/tr>\n
Septic and Well Application<\/a><\/strong><\/p>\n

Petition for VDH Services Form<\/a><\/strong><\/td>\n

Only owners that submit a petition for services and meet i) means testing requirements (household income does not exceed 100% of federal poverty guidelines), or ii) a hardship contained in the Virginia Department of Health\u2019s Hardship Guidelines, will be eligible to receive evaluation and design services from the Virginia Department of Health.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n\n\n\n\n
<\/td>\n<\/tr>\n
<\/td>\n<\/td>\n<\/tr>\n
Hotel Operation Permit Application<\/a><\/strong><\/td>\nApplication for a Hotel Operation Permit (hotel, motel and\/or Bed & Breakfast). There is a $40.00 annual free.<\/td>\n<\/tr>\n
Summer Camp Permit Application<\/strong><\/a><\/td>\nApplication for a Department of Health Summer Camp Permit<\/td>\n<\/tr>\n
Campground Operation Permit Application<\/a><\/strong><\/p>\n

Campground Plan Review Application<\/a><\/strong><\/td>\n

Application for a Campground Operation Permit is a legal form you must send to your local health department. It gives you permission to run a campground, RV park, or recreational camp.<\/span><\/p>\n

The Campground Plan Review Application requires the applicant to attach a site map of campground showing all campsites, sanitary facilities, and other amenities. This ensure that the proposed, built, or renovated campgrounds are safe, functional, and compliant with local, state, and environmental regulations before operation<\/span>.<\/td>\n<\/tr>\n

Tourist Establishment Regulation<\/a><\/strong><\/td>\nVirginia Department of Health’s webpage with information on pool and spa safety, as well as campground, summer camp and lodging permit information.<\/td>\n<\/tr>\n
Migrant Labor Camp Application<\/a><\/strong><\/td>\nApplication for a Migrant Labor Camp Permit<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n\n\n\n\n
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Epidemiology Forms<\/b><\/span><\/h2>\n<\/td>\n<\/tr>\n

\n

Name:<\/b><\/span><\/h3>\n<\/td>\n

\n

Description:<\/b><\/span><\/h3>\n<\/td>\n<\/tr>\n

VDH EPI 1 Report (Confidential Morbidity Report)<\/a><\/strong><\/td>\nForm to report disease cases to your local health department.<\/td>\n<\/tr>\n
Instructions for the Electronic Morbidity Reporting Portal<\/a><\/strong><\/td>\nEPI1 Portal Instructions<\/td>\n<\/tr>\n
Electronic Morbidity Reporting Portal<\/a> (EPI1)<\/strong><\/td>\nThis is the link to the EPI1 Portal website. The purpose of this electronic form is to submit reportable diseases or conditions<\/a> to the Virginia Department of Health. <\/span>If you are reporting a rapidly reportable condition, please call your local health department directly.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

These documents are currently being remediated for accessibility. If you need assistance, please reach out to chdwellness@vdh.virginia.govH<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

All applications and forms are to be turned in to your local health department. Contact your local health department with questions regarding these applications and forms. 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