Public Health Templates

This Form is used for reporting and investigating cases of plague, a dangerous infectious disease.

This document is used for tracking and reporting cases of pertussis, a contagious respiratory infection commonly known as whooping cough. It helps healthcare providers gather information necessary for surveillance and prevention efforts.

This document is for collecting data related to mumps cases as part of surveillance efforts.

This form is used for reporting cases of Brucellosis, a bacterial infection that can be transmitted from animals to humans. It collects important information about the infected individual and helps healthcare professionals track and monitor the disease.

This form is used for reporting cases of Q Fever, a bacterial infection that can cause flu-like symptoms and is transmitted to humans from animals.

This form is used for reporting cases of leptospirosis, a bacterial infection spread through contact with contaminated water.

This application is used to seek approval for the plans of a food service establishment in Monroe County, New York.

This document is a petition form used by residents of Blackman Charter Township, Michigan to request the installation or repair of a sanitary sewer system.

This document is used for applying for approval for the subdivision of land in Warren County, Ohio for a minor subdivision.

This document is a Covid-19 Exposure Questionnaire specific to Orange County, Florida. It is used to gather information about potential exposure to the virus in the area.

This document is for applying for Lead Safe Certification in the City of Cleveland, Ohio. It is used for ensuring that properties meet safety standards for lead exposure.

This document is for applying to operate a mobile food facility at a temporary event in San Francisco, California.

This document is an application form for obtaining a Body Art Establishment Certificate in the City of Philadelphia, Pennsylvania. It is required for individuals or businesses operating a body art establishment such as a tattoo or piercing studio.

This document is for filing a complaint about a pesticide incident or illness in Riverside County, California.

This document is used for requesting the lifting of a stay imposed by the CDC in Cuyahoga County, Ohio. It is typically filed in court.

This form is used for reporting cases of swine influenza.

This document examines the racial disparities in lead poisoning rates in Chicago neighborhoods from 1995 to 2013. It explores the toxic inequality that exists and highlights the impact on different racial groups.

This document provides information on the flexibilities CMS has implemented for laboratories to combat the COVID-19 pandemic. It covers measures such as expanded testing options and regulatory relief.

This document describes Phase Three of the Forward Virginia plan, which outlines the guidelines and restrictions in place for the state of Virginia during the COVID-19 pandemic. It provides information on what businesses and individuals can expect during this phase of reopening.

This type of document is a pocket card that provides information and reminders about getting vaccinated for Hepatitis A.

This form is used for reporting confidential information about communicable diseases in the state of Indiana.

This document is used for reporting diseases in the state of Louisiana.

This form is used for reporting and investigating housing complaints in New Hampshire. It is typically used by a health officer to document and address issues related to unsafe or unsanitary living conditions.

This type of document allows residents of New Hampshire to choose not to participate in the Immunization/Vaccination Registry.

This form is used for registering cancer cases in the state of New Hampshire. It is part of the public health effort to track and monitor cancer incidence in the state.

This document is used for recording the vaccination history of individuals for Hepatitis A in the state of New Hampshire.

This Form is used for quarterly reporting for the New Hampshire Syringe Services Program in New Hampshire.

This form is used for reporting notifiable diseases in Washington, D.C. It helps in tracking and monitoring infectious diseases to protect public health.

This document is a Carbon Monoxide Report specific to the City of Muskegon, Michigan. It provides information and data related to carbon monoxide levels in the city.

This form is used for submitting complaints about mosquito issues in the Village of Spencerville, Ohio.

This Form is used for reporting and submitting cases of Vesicular Stomatitis in Wyoming.

This form is used for ordering vaccines in the state of Wisconsin.