Our mission is to prevent disease, assure a healthful environment, prolong life, and promote well being for the citizens of Medina County.
Promote, Protect and Prevent
Local Calls: 330-723-9688
4800 Ledgewood Drive, Medina, OH 44256

Forms and Documents


Items are listed in alphabetical order.  Click on the appropriate letter to navigate more quickly.

A    B    C    D   E    F    G    H    I    J    K    L    M    N    O    P    Q   R    S    T    U    V    W    X    Y    Z



Acidified White Rice Preparation
Air Pollution Complaint Form
Animal Bite Report Form
Animal Bites in Campgrounds Guide
Animal Manure Management Recommendations
Animal Neuter Clinics
Animal Trappers List

back to the top


Bats and Rabies - CDC
Boil Advisory/Water Interruption Guidelines
Bond Form for Sewage Installers 2013

back to the top


Certificate of Installation for Pools/Spas
Checklist for Sewage System Evaluations
Choking First Aid
Cistern Cleaners List
Cistern Cleaning Procedure
Cistern/HWST Completion Form
Coliform Bacteria Information
Consumer Advisory Provision Guidance
Cooling Foods Safely
Cottage Foods Fact Sheet
Critical Control Points

back to the top



Effluent Testing Laboratories
Employees Must Wash Hands Sign
Environmental Division Fees

back to the top


Food - Frequently Asked Questions (FAQs)
Food- Plan Review Application
Food - Plan Review Guide
Food- Plan Review & License Fees
Food Inspecting Agencies Sign-Off Form
Food Risk Level Classifications
Food Security Guidance
Food Service License Transfer Form
Food Service Operation (FSO) Rules
Food Storage Guidelines
Food Temperature Requirements
FSO Definition

back to the top


Glove Use and Handwashing

back to the top


Hand Sanitizer Fact Sheet
Heat Treatment Dispensing Freezer Daily Log
Hepatitus C Information

back to the top


Indoor Air Quality Fact Sheet
Infectious Waste vs. Solid Waste
Infectious Waste - Disposal of "Sharps"
Infectious Waste - Disposal of Trauma Scene Waste
Infectious Waste - Generator Registration

Infectious Waste- Household Hazardous Waste Reduction Hints
Injury Report Form - Camps

back to the top




Lead Poisoning Assessment Sheet
Lead Risk Assessor List
Level One Certification Registration Form
Lot Split Application Form

back to the top

Medical Gas Permit Application 2014
Medical Gas Registration Application 2014
Medina County Sanitary Code Chapter 29
Mercury Cleanup Kit Information
Mercury Fact Sheet
Mercury in the Household
Mercury Spills Fact Sheet
Microbiological Laboratories List
Mobile FSO Definition
Mobile Food Service Plan Review Guide
Mobile RFE Definition
Mold Information Packet

back to the top


Nitrates and Nitrites - FAQs
Non-Potable Water Sample Request Form
NPDES Fact Sheet
NPDES Grab Sample Procedure
NPDES Notice of Intent (NOI) Application
NPDES NOI Application Instructions
NPDES Testing Guidelines
Nuisance Complaint Form

back to the top


Ohio EPA Site Evaluation Request Form
Open Burning Regulations

back to the top

Plumbing - Commercial Plumbing Permit Example
Plumbing - Residential Plumbing Permit Example
Plumbing - Contractor Registration Packet 2014
Plumbing - Registered Contractors List
Plumbing- Shower Liner Test Certificate
Pool and Spa Safety Act
Pool Operation Management Guidelines
Pool Program FAQs
Potassium Monopersulfate Information

back to the top



Rabies - "Take the Bite Out of Rabies" Flyer
Rabies Sample Submission Form
Rabies Specimen Pick-Up/Drop-Off Locations
Raccoon Pick-Up/Drop-Off Protocol
Raccoons and Rabies Flyer
Real Estate Evaluation Request Form
Restaurant Equipment and Supply Companies
Retail Food Establishment (RFE) Definition

back to the top


Scale Graph Paper
Sewage - Blank Pumping Log

Sewage - Installer Bond Form 2014
Sewage - Installer Registration Packet
Sewage - Pumper Registration Application
Sewage - Service Provider Registration Application
Sewage - System Designers List
Sewage - System Installers List
Sewage - System Pumpers List
Sewage - System Service Providers List
Sewage - Tank Abandonment Application
Sewage Treatment System Care and Maintenance Information
Site Review Instructions for New Construction
Site Review Form
Soil Evaluators List

back to the top


Tattoo - Licensed Establishments
Temporary Food Service Packet
Temporary FSO Definition
Temporary Park-Camp License to Operate Application
Thawing Food Safely
Thermometer Calibration Procedure
Tick Submission Form

back to the top



Variance Request Form

back to the top


Water - Cistern/HWST Completion Form
Water - Continuous Disinfection Completion Form
Water - Installation Permit Application
Water - Lead Analysis Request Form
Water - Nitrate Analysis Request Form
Water - Pond Completion Form
Water - Private Water Systems Contractor List
Water - Spring Completion Form
Water - Water Hauler List
Water - Well Completion Form
Water Hauler Registration Application
Water Testing Laboratories
Water Well Sampling Before Oil & Gas Drilling Information
Well Chlorination Guidelines
West Nile Virus - "Fight the Bite" Flyer

back to the top





Click this button to sign up for the Medina County Mass Notification System.

Have a suggestion for our website? Are you having a problem with the website? Share your thoughts here.