Forms

Below are the forms:

CABINET FOR HEALTH AND FAMILY SERVICES

Plan Application Form

Onsite Sewage Disposal Systems Application For Site Evaluation

Adolescent COVID-19 Vaccine Clinic Registration

Covid 19 Testing

COVID-19 Vaccine Questionnaire

4 Basic Steps to Food Safety at Home

Safe Food Handling: What You Need to Know

KY Religious Exemption Immunization Form

COVID-19

English

Spanish

CABINET FOR HEALTH AND FAMILY SERVICES DEPARTMENT FOR PUBLIC HEALTH APPLICATION FOR PERMIT/LICENSE

Step 1 of 4

TO BE COMPLETED BY APPLICANT – PLEASE PRINT LEGIBLY
Name of Establishment
Sort Name (Leave Blank): _______________________________________
Address
Street Address City State ZIP Code
Owner's Name:
Last 4 SSN
Mailing Address:
Street Address City State ZIP Code
Phone #
Home Phone:
Cell Phone:
Email:
Billing Address (if different from above)
Street Address City State ZIP Code
Phone #
Military Status
- Active Duty
- Reserves
- National Guard
- Honorably Discharged Veteran
I hereby certify that the above statements are true and correct to the best of my knowledge. I understand that a false statement may disqualify me for permits or licenses.
Applicants Signature:
Date
MM slash DD slash YYYY

Establishment GPS Coordinates
Latitude
DEG MIN SEC
Longitude
DEG MIN SEC

Unit Measure
Machines	A
Mobile Home Spaces	M
Rooms	R
Seats	S
Trucks	T
Gallons	G
Boarders/Beds	B

Machines (Quantity)

Machines (Quantity)
Mobile Home Spaces (Quantity)

Mobile Home Spaces (Quantity)
Rooms (Quantity)

Rooms (Quantity)
Seats (Quantity)

Seats (Quantity)
Trucks (Quantity)

Trucks (Quantity)
Gallons (Quantity)

Gallons (Quantity)
Boarders/Beds (Quantity)

Boarders/Beds (Quantity)

Unit Measure
Commisaries	C
RV Spaces	V
Feet	F
Male Student	M
Female Students	E
Residents	R
Square feet	Q

WCHD CONFIRMS MULTIPLE CASES OF COVID-19 IN WOODFORD COUNTY

Visit our Facebook page for the most up-to-date information regarding confirmed cases: https://www.facebook.com/woodfordhd/

While the risk to the general public is low, health officials are working with the Centers for Disease Control and Prevention (CDC) and Kentucky Department for Public Health (KDPH) to identify and notify all those who may have come in contact with the infected individuals. These individuals will be monitored for fever and respiratory symptoms.

Additional details about the persons affected cannot be provided due to medical privacy laws.

“At this time, we believe the risk to the general public is low, and as this situation evolves, we will continue to communicate with the CDC, KDPH and the people of Woodford County,” said Cassie Prather, Woodford County Public Health Director. “The best way to prevent illness is to avoid being exposed to this virus. However, there are everyday preventative actions you can take to help prevent the spread of this virus.”

The health department offers these tips:

Wash your hands often with soap and water, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.

Avoid close contact with people who are sick.

Avoid touching your eyes, nose and mouth.

Stay home when you are sick.

Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

The virus is thought to spread mainly from person-to-person:

Between people who are in close contact with one another (within about 6 feet).

Via respiratory droplets produced when an infected person coughs or sneezes.

These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

Stay up to date at: www.kycovid19.ky.gov and https://www.facebook.com/woodfordhd/

Woodford County Restaurant Update

Kentucky Gov. Andy Beshear on Monday announced that he plans to order all restaurants in the state to close to dining-in, beginning at 5 p.m. Monday, March 16, 2020.

Closing restaurants and bars to in-person service

Gov. Beshear said he will direct restaurants and bars to close, although there will be expectations for drive through and delivery. The Governor urged people to order take out when possible and support local businesses and their employees.

“We are to the point now where this is a step we have to take. I want to thank everyone that stepped up and did this voluntarily,” he said. “We are asking so many people to make sacrifices. It is not lost on me that most of these are small businesses. We are going to do everything we can to be there for you. We realize the impact this will have and we will be there for you.”

PROGRAM MODIFICATION UPDATE

Beginning Tuesday, March 17, 2020, our office will be open but will only be taking phone calls and answering emails. We will be providing essential services in-person, on an as-needed basis. Our focus is shifting to provide information to our healthcare community, provide resource management for the county, and provide epidemiological investigations.

We will do our best to maintain as many services as possible via telephone. If you are a participant of WIC or HANDS, please call us for additional guidance on how we can serve you in a way that protects your safety and wellbeing. Other services will be evaluated on an individual basis, and we will do our best to make them available as needed. We will offer as many services as possible while keeping limited contact with our clients.

The environmental office will be open on Monday mornings (until further notice) from 8-9:30 am while the plumbing inspector is open. Otherwise, please call and leave a message. At this time, we will be focusing on investigating complaints.

We are working diligently with CDC and the Department for Public Health to keep Woodford County healthy and safe. Please understand that we will do our best to make necessary services available to our community while also protecting the health of our staff.

Our phone number is (859) 873-4541. We can also be contacted via Facebook. Please be patient and understanding. We are all trying to figure out how to work under these unusual circumstances. Thank you in advance for your cooperation.

ISOLATION SURVEY

Number	Make	Model	Year	Capacity

Forms

Below are the forms:

Woodford County Health Department

Hours of Operation

Environmental Office Hours

Plumbing Inspector Hours

WOODFORD COUNTY

FREE COVID TESTING

WCHD CONFIRMS MULTIPLE CASES OF COVID-19 IN WOODFORD COUNTY

Woodford County Restaurant Update

PROGRAM MODIFICATION UPDATE