Siskiyou County Public Health Dept - Download Information & Forms

Public Health & Community Development Department

Download Information & Forms

Environmental Health Forms

Consumer Protection:

California Retail Food Code - Effective July 20, 2007 (633K)
Retail Food Facilities Check List for New Construction or Remodels (53K)
Food Facility Permit Application (12K)
Temporary Food Facility Checklist (40K)
Cottage Food Operation Application Guide (3.5 MB)

Code Enforcement:

Complaint Form (16K)

Land Use:

Incremental Development Permit Application (21K)
Individual Sewage On Site Review and Permit Procedure (207K)
Percolation Test Method (16K)
Sewage Disposal Permit (99K)
Water and Sewer Clearance Application (18K)
Water Well Construction / Destruction Permit Application (71K)
Well Log Release Authorization (8K)

Waste Management:

Environmental Health Information

Architects, Engineers, Land Surveyors (9K)
Contractors (20K)
Guide to Understanding Wet Weather Testing (287K)
Partial List of State Approved Water Labs in Northern California (12K)
Well Disinfection Brochure (32K)
Well Drillers (13K)

Personal Health Forms

Immunization Registry Consent (288K)
Medically Fragile Registry (79K)
Notice of Privacy Practices for the Use of Protected Health Information (24K)
Patient Medical History and Consent Form (105K)
Permission Slip - Immunizations - Children 2 months through 6 years (28K)
Permission Slip - Immunizations - Children 7 years through 17 years (28K)
Permission Slip - Seasonal Flu Vaccine (48K)
Request for List of Disclosures (25K)
Confidential Morbidity Report (725K)
Confidential Morbidity Report-Tuberculosis (680K)
Confidential Morbidity Report-DMV (640K)
Confidential Morbidity Report-Animal (772K)

Personal Health Information

Vaccine Information Statement - Nasal Spray (48K)
Vaccine Information Statement - Shot (52K)

Fee Schedules

Environmental Health Fee Schedule (PDF - 32K)
Personal Health Fee Schedule (PDF - 18K)