Health Department Forms

Well Mapping Form

In the summer of 2006 a project was initiated to inventory and geo-locate all of the private drinking water wells in Howard County. Using updated technology, the dated files currenly in use will be more precise.  Also, If there were ground water issues in a specific area, the Health Department would be able to accurately identify those affected and notify communities if necessary.   Click here for the Well Mapping Form.

Health Related Issues Complaint Report

The Health Related Issues Complaint Form allows you to report nuisance conditions or potential health issues you have seen in Howard County. Our Department will investigate all reports to determine if a hazardous condition exists and work to resolve any issues as quickly as possible.  If you are completing the Health Related Issues Complaint Report because you think you have an illness related to eating bad food or food product, please call our Bureau of Environmental Health immediately at 410- 313-1772. After business hours, leave a message with your callback information.   Click for the Health Related Issues Complaint Form.


Smoking Violation Report Form

Fill in the form and a report will be sent to the Howard County Deparment of Police. The establishment or location that you have reported being in violation will be added to a "Watch List" that is distributed to a network of County agencies who routinely regulate various aspects of public establishments.  Click for the Smoking Violation Report Form.


Tanning Complaint Form

The Howard County Tanning Facility Regulations allows a person who believes that a violation of the regulations has occurred to file a complaint with the Howard County Health Officer. The Health Officer or designee will investigate the complaint.  If you believe that you have been injured due to tanning device use (got a skin or eye burn, been hurt by the equipment) you should file an injury report with the person-in-charge of the facility first, then complete the form.  Click for the Tanning Complaint Form.
Disclosure: 
If you choose to use these online forms, your contact information (name and phone number) will be required to verify your complaint. An inspector may contact you for additional information. Our Department does not disclose the identity of persons filing complaints during the investigation of the complaint. You may also report the nuisance by phone at 410-313-1773.

Community Outreach Form

Howard County Health Department (HCHD) is committed to helping educate the community we serve.  We proudly participate in a variety of local health fairs, educational series, and community events throughout the year.  If you are interested in having the Howard County Health Department present at your next event, please read the following guidelines before completing the online Community Outreach Request form. 

Guidelines:

  • Requests should be submitted online at least 30 days prior to the event date.
  • Participation at your event is based on HCHD staff and/or volunteer availability.
  • If we are unable to attend, we may be able to provide brochures about our services to distribute at your event and/or suggest other sources for printable materials that can be downloaded.
  • Questions about our Community Outreach Event request process may be directed to askhealth@howardcountymd.gov 

Use this form to request Health Department participation in your health fair or health event.  

Fax to 410-313-5961
Email to: askhealth@howardcountymd.gov
Mailing address: Howard County Health Department 
8930 Stanford Blvd. Columbia, MD 21045
Attn: Health Fairs 
Click to download the fillable Health Education Request Form (.pdf)

Public Information Act Request Form

Bureau of Environmental Health
8930 Stanford Blvd. Columbia, MD 21045
(410) 313-2640 (voice/relay)
(410) 313-2648 fax
Toll Free 1-866-313-6300
Forms:
Environmental Public Information Act Request Form (.pdf) - for Well & Septic, Food Protection Program or Community Hygiene Program information

General Public Information Act Request Form (.pdf) - for all other Health Department information requests

County Pool Operators Application

If you intend to operate a public or semi-public swimming pool, you must have passed a recognized and approved pool operator course. In addition you must submit a Howard County Pool Operator Application. Complete instructions are included in the application.  Click on this sentence to download the application.


Health Insurance Portability and Accountability Act (HIPAA) 

Notice of Privacy Practices Notice of Privacy Practices The Howard County Health Department is committed to protecting the health information of all clients. In accordance with the HIPAA Privacy Rule, the following Notice of Privacy Practices is provided to all individuals that receive services provided by the Health Department