Forms, Applications, & Records Requests
Forms & Applications
FOIL & Records Requests
- Nassau County Electronic FOIL Request Online Form (for general use)
- Food Service Establishment Inspection Records
- Realty Subdivision and Commercial On-Site Sewage Disposal Records Request Form
- Small Petroleum Tank Abandonments and Removals Records/Verification Letters
- Source Water Assessment Program (SWAP) Records Request
- Medical Records: For a copy of your or your child’s Health Department medical records, privacy laws require that you submit a signed HIPAA-compliant "Authorization Form to Release Health Information" available here.
There is a 25-cent, per-page fee for copying most records and copies of medical records cost 75 cents per-page. The fees for paper copies of Source Water Assessment Program records are 25 cents per-page and 50 cents per color map (8.5”x11”). The fees for duplicating engineering plans vary from plan to plan, therefore you will be notified of the cost for the specific plans you request.
For a Food Service Establishment Permit, please contact the Office of Food Protection at 516-227-9717 or visit their webpage for more information.
Temporary Events Applications
- Sponsor Application for Temporary Event
- Food Vendor Application for Temporary Event
- Temporary Event Food Vendor Minimum Requirements
- Temporary Event Fee Schedule
Small Heating Tank Closure Program: All closures (abandonments or removals) of small (< 1,100 gallons) heating oil tanks located at facilities that DO NOT fall under NCPHO Article XV regulation, such as small heating oil tanks at homes, must be scheduled with this office using the online scheduling system. Paper applications should no longer be submitted to this office for these types of tank closures.
- Pool Safety Plan
- Bathing Beach Safety Plan
- Recreational Aquatic Spray Grounds Safety Plan
- Daily Pool Log
- Injury/Illness form
- Lifeguard Application: Click here for copies of the lifeguard certification instructions, application instructions and application form.
The Nassau County Medical Reserve Corps (MRC) is a community based, civilian, volunteer program that is committed to help strengthen local public health initiatives, as well as respond to disasters in our area. For more information and to download the MRC brochure and application, please click here.