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

Records Requests

ECHD Records Request - This form can be used to request any public records from Environmental Health Services. Print this form and submit by mail, fax or deliver in person.

Patient Services Forms

Health Education Forms

Environment Health Forms

Swimming Pool Injury Report

Daily Log Form

Swimming Pool Signage- List of required signs at public swimming pools.

Pool Operator Info - General information and reminders for public swimming pool operators

Elkhart County Swimming Pool Ordinance

Keeping Afloat

Pool License Application- Commercial Swimming Pool License Application

Pool Plan Review Review Checklist

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.

Elkhart County Food Ordinance

Food Service Self Checklist- Food Service Operators can use this checklist as a self evaluation tool to promote and ensure safe food handling in their facilities.

Home Based Vendor Guidelines

Mobile Food Service Requirements- Lists the minimum requirements that must be met to operate a mobile food service in Elkhart County.

Consumer Advisory

Certified Food Manager Law

Sample Employee Health Policy

Sample Employee Health Policy Questionnaire

Not for Profit Registration Form

Temporary Event Coordinator App- Temporary Event Coordinators must fill out this application and submit by fax or mail at least 30 days prior to their event.

Food Service License Application

Temporary Food Guidelines - Guidelines for operating a temporary food service in Elkhart County.

Food Safety News

Plan Review Packet- This packet will help prepare plans for constructing or remodeling a food service. Please follow the instructions carefully.

IDEM Open Burning Brochure- This brochure from the Indiana Dept. of Environmental Management explains the State's open burning law and gives alternatives to burning. A link to the current site is here.

Conrail Superfund Site -Provides information about the Conrail Superfund site in Elkhart and Saint Joseph Counties including location, contaminants and, answers to frequently asked questions. An older document of this can be found here.

Groundwater Protection Ordinance

Drinking Water Testing Labs

Wastewater Characterization- This a list of laboratories or consultants capable of doing wastewater characterizations required by Elkhart County Groundwater Protection Ordinance.

GW Registration Brochure- This brochure gives a brief overview of the Groundwater Protection Ordinance requirements and includes a registration form facilities can use to register with the Health Department.

Application for Construction Permit

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 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 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