Animal Encounter:
SG-58 Animal Encounter Report Form

  • For Healthcare Provider/Facility Attending to Animal Bite Patient

Body Piercing/Tattoo Studios:
SG-49 Application for Permit to Operate
SG-86 Piercing Studio Plan Review
SG-88 Piercing Technician Certification Application
SG-89 Information & Notification
SG-90 Hepatitis B Declination
64-80A Body Piercing Studio Rule Public Notice

Child Care Centers:
SG-49 Application for Permit to Operate
SG-99 Plan Review Information for Child Care Centers (New or Remodeled)

SG-51 Complaint Form
You can also fill out the Complaint Form online 

Food Sanitation:

SF-4 Guidelines for Operating a Temporary Food Service Concession

SF-5 Food Establishment Permit Application

SF-5B Temporary Food Establishment Permit Application

SF-7E Inspection Guide -2013 FDA Food Code
SF-35 Plan Review for New or Remodeled Food Establishments
Form 1-A Applicant Food Employee Interview
Form 1-B Food Employee Reporting Agreement
Form 1-C Applicant and Food Employee Medical Referral
PHSD Retail Food Emergency Flip Chart

General Sanitation:
SG-49 General Sanitation Permit Application

Manufactured Home Community:
SG-49 Application for Permit to Operate
EG-1 Manufactured Home Community Specification and Plan Review Summary Form
EG-2 Application for a permit to Construct, Install, Alter, or Extend a Manufactured Home Community
EG-4 Sewage System Information and Design Data Sheet
EG-5 Water System Design Information and Data Sheet

Recreational Water Facilities:
SG-49 Application for Permit to Operate
ER-32 Recreational Water Facility Weekly Report
SR-153 Recreation Water Facilities Tables

SS-182A Application to Install or Modify a Small Sewage Disposal System
ES-57 Affidavit

     Subdivision Forms:
     ES-76 Subdivision Application
     Septic Tank Cleaner Forms:
     SS-181 Application For Sewage Tank Cleaning Permit
     For Installers Only:
     SS-192 Installer Certification Renewal Application

SW-252c Springs
SW-252d Cisterns
SW-252e Installing a Hand Pump
SW-252g Pit-less Units
SW-253 Request for Water Analysis
SW-256 Water Well Application
SW-258 Water Well Completion Report

SW-259: Water Well Violation Report

SW-260 Water Well Variance Request
SW-261 Water Well Abandonment Report
SW-262 Water Well Pump Installation Report

Listing of West Virginia Certified Drinking Water Laboratories
Private Water Well Owners–What to Do Before Drilling the Well
Private Water Well Owners–Water Well Pumping Systems
Private Well Owners-Four Steps to Water Well Safety
How to Disinfect a Private Water Well

Applications and Forms

All Applications and Forms are in PDF format and require that your computer be running Adobe® Acrobat Reader software. 

Please Note: If you experience difficulty in downloading or printing forms, please refer to the Adobe Web Site for troubleshooting and support guidelines.

If you have any questions or concerns, please contact us for further assistance.

Environmental Services

Health Department