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(304)530-6355

Hardy County Health Department
Hardy County Health Department
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    • Food Safety
    • Other Programs
    • Rabies and Vector Info
    • Regulations
    • Sewage and Water
  • Preparedness
    • Preparedness Services
  • More
    • Home
    • About
      • Board of Health
      • Calendar of Events
      • Disclaimer
      • News and Notes
      • Payment Options
      • Privacy Policy
      • Resources
    • Clinical
      • Clinical Services
      • Breast and Cervical
      • Communicable Disease
      • Family Planning
      • Immunizations
      • Pediatric Health Check
      • STD and HIV Testing
      • Tuberculosis
    • Environmental
      • Environmental Services
      • Applications and Forms
      • Clean Air
      • Complaint Form
      • Food Safety
      • Other Programs
      • Rabies and Vector Info
      • Regulations
      • Sewage and Water
    • Preparedness
      • Preparedness Services

(304)530-6355


  • Home
  • About
    • Board of Health
    • Calendar of Events
    • Disclaimer
    • News and Notes
    • Payment Options
    • Privacy Policy
    • Resources
  • Clinical
    • Clinical Services
    • Breast and Cervical
    • Communicable Disease
    • Family Planning
    • Immunizations
    • Pediatric Health Check
    • STD and HIV Testing
    • Tuberculosis
  • Environmental
    • Environmental Services
    • Applications and Forms
    • Clean Air
    • Complaint Form
    • Food Safety
    • Other Programs
    • Rabies and Vector Info
    • Regulations
    • Sewage and Water
  • Preparedness
    • Preparedness Services

Hardy County Health Department

Applications and Forms

Animal Encounters

For Healthcare Provider/Facility
SG-58 Animal Encounter Report Form

Body Piercing/Tattoo Studios

SG-49 Application for Permit to OperateSG-86 - Plan Review Information Report (for new or remodeled studios)SG-88 Piercing Technician Certification ApplicationSG-89 - Client Information and Notification Form (Sample)SG-90 - Hepatitis B Vaccination Declination Statement68-80A - Public Notice: Body Piercing Disclosure Statement

Child Care Centers

SG-49 General Application for PermitSG-99 Child Care Center Plan Review

Complaint Form

Online Complaint Form

Food Sanitation

SF-4: Guidelines for Operating a Temporary Food Service Concession (booklet layout)SF-5: Application for Permit to Operate a Food Service EstablishmentSF-5B Application for Permit to Operate a Temporary Food Service EstablishmentSF-7E: Inspection Guide - 2013 Food CodeSF-35: Plan Review Information Report for Food Service Establishments (new or remodeled)SF-35 Addendum: Information PacketForm 1-A: Applicant and Food Employee InterviewForm 1-B: Food Employee Reporting AgreementForm 1-C: Applicant and Food Employee Medical ReferralRetail Food Establishment Emergency Flip Chart

FOOD SANITATION - Mobile Food Establishments

HB 5017 - Establishes a Statewide Mobile Food Establishment
SF-47 Application for a Statewide Food Establishment PermitSF - 51 Application Out-of State Mobile Food Establishment Permit

General Sanitation

SG-49 General Application for Permit

Manufactured Home Community

SG-49 General Application for PermitForm EG-1 Manufactured Home Community Specifications and Plan Review Summary FormForm EG-2 (Application for a Permit to Construct, Install, Alter, or Extend a Manufactured Home Community)

Recreational Water Facilities

SG-49 General Application for PermitER-32 Recreational Water Facility Weekly ReportSR-153 Recreation Water Facilities Tables

Sewage

SS-182A Application to Install or Modify a Small Sewage Disposal SystemES-57: Affidavit for an Existing Sewage Disposal SystemSS-196 UIC Permit CriteriaSS-197 Change of Certified Installer
For Installers Only:
SS-192: Sewage System Installers Application for Renewal of CertificationSS-192 Installer Certification Renewal Application (ONLINE)
Septic Tank Cleaner Forms:
SS-181 Application For Sewage Tank Cleaning PermitSS-193: Septic Tank Cleaner - Quarterly Log
Subdivision Forms:
ES-76: Subdivision Approval Application Form

Water

SW-252c SpringsSW-252d CisternsSW-252e Installing a Hand PumpSW-252g Pit-less UnitsSW-253: Request for Water AnalysisSW-256 Water Well ApplicationSW-258 Water Well Completion ReportExplanation and Guide to Completing The SW-258SW-259: Water Well Violation ReportSW-260: Water Well Variance Request FormSW-261: Water Well Abandonment ReportSW-262: Water Well Pump Installation ReportExplanation and Guide To Completing The SW-262
Safe Drinking Water Information
How to Disinfect a Private Water WellWater Well Pumping Systems - Private Well OwnersWhat to Do Before Drilling the Well - Private Well OwnersFour Steps to Water Well Safety - Private Well OwnersListing of West Virginia Certified Drinking Water Laboratories

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