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Elkhart County Health Department Forms

The following is a list of downloadable forms sorted by individual departments. You may search from the search bar above or simply scroll through the list below. Many of the forms and documents here are also conveniently located on the service's subpages. If you do not see a particular form, please reach out to us for assistance.

COVID-19 Forms

The following are a list of downloadable and linked forms as it pertains to COVID-19

ECHD Records Requests

  • ECHD Records Request Form
    This form can be used to request any public records from Environmental Health Services. You can submit this form digitally, by mail, fax, or it can be delivered in person.

Patient Services Forms

Health Education Forms

Environment Health Forms

  • Spill Packet
    This packet includes a list of clean-up contractors with the ability to respond to hazardous materials spills and a form that can be used to document spill reporting and clean-up response activities.

  • Stop Raising Mosquitoes
    This pamphlet provides information on ways to reduce mosquito breeding sites around your home.
  • Mosquito-Borne Diseases
    This pamphlet contains information about several diseases spread by mosquitoes.
  • Ticks and Disease
    This pamphlet provides information about several species of ticks and the diseases they can carry.
  • Application For Septic Permit
    This form is provided to show what information is required to apply for a septic permit. This form must be filled out in original and can be obtained at the Environmental Health Services Division office.
  • Plan Submittal Checklist
    Checklist for Septic System Plan Submittal for New, Repair/Replacement Onsite Sewage Disposal Systems.
  • Marking Utilities
    This is an information sheet concerning the marking of utilities before construction and soil evaluations/soil borings.
  • ECHD Septic Ordinance Section 5
  • Septic Lookup Request
    Use this form to request information on existing onsite sewage systems either by fax or by presenting to our office. Note: There is no information available for homes/addresses constructed prior to 1967.
  • Sample "To Scale" Drawing
    "To Scale" drawings are required with all application submissions for an onsite sewage disposal system permit.
  • Flood Dose Worksheet
    This worksheet must be submitted at the time of application when minimum requirements indicate a flood dose installation.
  • Mound/Press Dist Worksheet
    This worksheet must be submitted at the time of application when minimum requirements indicate an elevated sand mound system or pressure distribution system installation.
  • Onsite Evaluation Request
    Use this form to request an onsite evaluation/soil boring from ECHD for residences. This form can be completed at the ECHD Environmental Health Services Office or it can be printed and mailed or faxed to our office at (574) 875-3376.
  • Septic System Care and Feeding B
    A guide from the EPA for the homeowner's care of their onsite system.
  • Development standards
    Environmental Health Technical Review and Development Standards.
  • Wastewater Treatment Matrix
    Wastewater Treatment Assessment Matrix
  • ECHD Septic Ordinance - Ordinance No. 2012-153
    An ordinance regulating private sewage disposal systems in Elkhart County.
  • Minimum Requirements
  • Septic Permit Procedure Guide
    This guide explains the process for obtaining a private sewage disposal system permit, for new construction.
  • Installer Registration Form
    This form is used to register septic installers in Elkhart County.
  • Protect Your Family
    This pamphlet is an excellent resource. Landlords and sellers of homes, built before 1978, are required by law to present this pamphlet to the new owners or tenants to warn about potential lead hazards in the home. This law applies even if the landlord or seller has no specific knowledge about lead hazards in the home (English).
  • Spanish Protect Your Family
    This pamphlet is an excellent resource. Landlords and sellers of homes, built before 1978, are required by law to present this pamphlet to the new owners or tenants to warn about potential lead hazards in the home. This law applies even if the landlord or seller has no specific knowledge about lead hazards in the home (Spanish).
  • Lead Paint Safety A Field Guide
    This guide is part of HUD's approach to lead safety in the home. It will show you how to safely perform work around lead in a residence built before 1978 (English).
  • Spanish Lead Paint Field Guide
    This guide is part of HUD's approach to lead safety in the home. It will show you how to safely perform work around lead in a residence built before 1978 (Spanish).
  • Reducing Hazards during renovation
    This pamphlet is designed for contractors to help them determine what they can and cannot do when disturbing lead-based paint.
  • Prerenovation Education Rule
    This brochure outlines the requirements for contractors, property managers, and others who perform renovations for compensation in residential housing that may contain lead-based paint.
  • Property Manager Responsibilities
    This pamphlet is designed for landlords and apartment managers who are committed to providing a safe and habitable property for their tenants that complies with state and federal laws.
  • New Indiana Habitability English
    This brochure details landlord obligations, liabilities, and disclosure rules for Indiana properties (English).
  • New Indiana Habitability Spanish
    This brochure details landlord obligations, liabilities, and disclosure rules for Indiana properties (Spanish).
  • EPA and HUD disclosure
    This brochure has questions and answers pertaining to federal lead disclosure laws.
  • Lease Disclosure English
    EPA Title X requires landlords to disclose lead hazards by giving this form to tenants prior to leasing most residential homes built before 1978 (English).
  • Lease Disclosure Spanish
    EPA Title X requires landlords to disclose lead hazards by giving this form to tenants prior to leasing most residential homes built before 1978 (Spanish).
  • Sale Disclosure English
    EPA Title X requires sellers to disclose lead hazards by giving this form to buyers of most residential homes built before 1978 (English).
  • Sale Disclosure Spanish
    EPA Title X requires sellers to disclose lead hazards by giving this form to buyers of most residential homes built before 1978 (Spanish).
  • Finding a Qualified Lead Professional for Home
    This pamphlet will help you find a lead professional who will tell you if your home has lead paint in a form that may pose a hazard to your children.
  • Lead Contractors and Home Testing
    This is a list of regional and local lead contractors and appropriate cleaning and home testing suppliers.
  • Evaluating Homes for lead hazards
    This pamphlet is designed for the risk assessor, inspector, and clearance examiner so they understand their role in evaluating the property and their responsibilities and to better inform their clients.
  • Lead- Who's at risk?
  • Lead- Who's at Risk? Spanish
  • Elkhart County Lead Elimination
  • Consolidated Plan for Housing
  • Participation Interest Form, HUD
    HUD Lead Grant Participation Interest Form

Vital Records Forms

Elkhart County Health Department

608 Oakland Avenue Elkhart, IN 46516-211

Hours

Tuesday through Friday: 8:00am-4:00pm

Phone

574-523-2127