{"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":"2026-04-03T11:55:26","modified_gmt":"2026-04-03T15:55:26","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

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

Event Coordinator Application<\/a><\/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><\/td>\n<\/td>\n<\/tr>\n
FDA Federal Food Code Document<\/a><\/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 Unit Plan Review Document<\/a><\/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
\n

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><\/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><\/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><\/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><\/p>\n

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

Other Applications, Forms, & Regulations<\/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

Hotel Application<\/a><\/td>\nApplication for a Department of Health Tourist Establishment\/Campground\/Summer Camp Permit<\/td>\n<\/tr>\n
Summer Camp Application<\/a><\/td>\nApplication for a Department of Health Summer Camp Permit<\/td>\n<\/tr>\n
Application for a Campground Operation Permit<\/a><\/p>\n

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

An 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><\/td>\n<\/tr>\n
Tourist Establishment Regulation<\/a><\/td>\n<\/td>\n<\/tr>\n
Migrant Labor Camp Application<\/a><\/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
\n

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

EPI 1 Form PDF<\/a><\/td>\nForm to report disease cases to your local health department.<\/td>\n<\/tr>\n
Electronic Morbidity Reporting Portal EPI1<\/a><\/td>\nEPI1 Portal Instructions<\/td>\n<\/tr>\n
Electronic Morbidity Reporting Portal<\/a> (EPI1)<\/td>\nEPI1 Portal<\/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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