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Environmental Health Forms

Here is a list of Environmental Health Services (EHS) forms that are available to download.  You will need Adobe Acrobat Reader in order to download these forms.  To download a free copy of Adobe Acrobat Reader, click here.



*Catering Establishment Checklist

*Fee Schedule  

*Food Service Establishment Checklist

*Food Service Establishment Permit Application [see below for Temporary Food Application]
[must be submitted not less than 21 days before starting operation]

*Freedom Of Information Law Request Form

*Mobile Food Unit Checklist

*Pool Operation Report (DOH-1323) 

*Public Water System Monthly Operation Report (DOH-360)

*Renewal of STS Construction Permit Application

*Sewage Treatment System (STS) Construction Permit Application 

*Temporary Food Service Permit Application
[must be submitted not less than 10 days prior to ensure having permit in time for event]

*Temporary Food Service Checklist




Chemung County Health Center
103 Washington Street
Elmira, NY

Public Health

Environmental Health
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