Public Health Templates

This form is used for creating an administrative summary for private water systems in the state of Ohio. It helps in documenting important information and ensuring compliance with regulations.

This document provides instructions for Ohio residents on how to collect lead and copper samples for testing. It helps residents ensure the safety of their drinking water.

This Form is used for investigating cases of illness transmitted by mosquitoes in Ohio. The form helps gather information about suspected cases to determine the cause and prevent further spread of the illness.

This form is used for reporting confidential diseases in the state of Ohio.

This document is a template used in Oregon to implement time as a public health control in food establishments. It provides guidelines for monitoring and documenting the time that certain foods are held at room temperature to ensure their safety for consumption.

This document is a stay-at-home order issued by the director of Ohio, requiring residents to stay at home to prevent the spread of COVID-19.

This document provides guidance for schools and day care programs in Illinois on how to address and prevent the spread of COVID-19. It includes recommendations for mitigation measures, cleaning and disinfection, testing and contact tracing, and other important considerations.

This document provides information on the use of cloth face coverings to prevent the spread of COVID-19 in New Hampshire.

This document is used for WIC/Medicaid nutrition purposes in the state of Washington.

This document is for applying for a permit to install a sewage disposal system in the Town of Greenville, New York.

This document is for recertifying or renewing Medicaid benefits in Washington, D.C. It is available in Amharic.

This form is used for reporting cases of Hepatitis A in the state of Washington.

This document is used for submitting environmental samples for Legionella testing and maintaining a record of custody in Washington.

This form is used for obtaining a certificate of exemption from immunization requirements in the state of Washington. It is available in both English and Spanish.

This form is used for obtaining a certificate of exemption from immunization requirements in Washington. It is available in both English and Chinese Simplified.

This Form is used for ordering fluoride in well water for families with children under the age of 4 in Vermont.

This form is used for reporting arboviral diseases in Washington state.

This document is used for reporting cases of Burkholderia infection in the state of Washington.

This form is used for reporting cases of cryptosporidiosis in the state of Washington.

This form is used for reporting cases of diphtheria in Washington state.

This Form is used for reporting cases of cholera in the state of Washington.

This form is used for reporting cases of Hepatitis E in Washington state. It is used by healthcare providers to track and monitor the spread of this disease.

This form is used for reporting cases of leptospirosis in Washington state.

This form is used for reporting cases of malaria in Washington state. It helps the Department of Health track and monitor the spread of the disease in order to take appropriate public health measures.

This form is used for reporting cases of measles in the state of Washington.

This form is used for reporting cases of mumps in the state of Washington.

This form is used for reporting cases of plague in Washington state.

This form is used for reporting cases of human prion disease in Washington state.

This form is used for reporting cases of pertussis (whooping cough) in the state of Washington.

This form is used for reporting cases of psittacosis, a respiratory illness caused by exposure to infected birds, in the state of Washington.

This document is a reporting form used in Washington state for reporting cases of Poliomyelitis/Acute Flaccid Myelitis (AFM).

This form is used for reporting rare diseases of public health importance in the state of Washington.

This form is used for reporting cases of shigellosis, a contagious bacterial infection, in Washington state.

This form is used for reporting verified cases of tuberculosis to the Centers for Disease Control and Prevention. It provides important information about the individual diagnosed with tuberculosis and helps in tracking and monitoring the spread of the disease.

This form is used for reporting cases of Trichinosis in the state of Washington.

This form is used for reporting Varicella (chickenpox) related deaths in the state of Washington.

This Form is used for reporting cases of West Nile Virus Disease in Washington state.

This form is used for reporting cases of yellow fever in Washington.

This form is used for reporting cases of Yersiniosis in the state of Washington.