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. 

Community Outreach Form

*** Due to COVID-19, the Health Department will not be participating in in-person community outreach events.***  We are happy to provide educational materials and virtual presentations to your organization.  Our ability to honor your request is based on staffing and alignment with HCHD mission and vision. Please complete the Community Health Virtual Education Request Form and a Health Promotions staff member will contact you.

For additional questions or information, please contact us at askhealth@howardcountymd.govPlease see the links below for COVID-19 information and resources. 

Cribs for Kids Program 

The Health Department manages this program in partnership with national Cribs for Kids. The program provides a free portable crib to families that are in need, as well as providing education about a safe sleep environment.  There is no cost for the program, but a referral is required. Program referral form

Kids in Safety Seat Program 

This program in partnership with Maryland Kids in Safety Seats (KISS) and Howard County Safe Kids Coalition provides a new, low-cost car seat to families who are income-eligible and provides education about car seat safety and installation. There is a $40 fee for the program and a referral is required. Program referral form

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
Public Information Act webpage
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.

Tobacco Awareness Program for Teen (TAFPT) Enrollment Form

This free education program is designed for students who violate school policy on underage tobacco use. This program may also serve as primary prevention (education) for parents, educators, or general community members who may be concerned for a child or youth's risk of using tobacco products.  Click to fill out the Enrollment 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 num