Environmental Health

PROGRAMS

Food Protection Program

Temporary Food Events
Food Service Operations
Foodborne Illnesses
Farmers Markets

Private Sewage Disposal

Forms (examples: Plot Survey Request and Loan Evaluation Request)
Registered Contractors
Fee Schedule
Contractors Registration Forms
Private Sewage Disposal Codes and Ordinances

Wells

Well Forms for Contractors
Well Sealing Forms
Closed Loop Well Forms
Ordinances and Codes
Water Sampling

Indoor Air Quality

Solid Waste and Nuisance Complaints

MAKE AN ENVIRONMENTAL HEALTH PAYMENT

Certified Food Manager Course Registration

Steps

1. Step One This section is complete This section is incomplete
2. Demographics This section is complete This section is incomplete
3. Employment Information This section is complete This section is incomplete
4. Payments This section is complete This section is incomplete
5. Signature This section is complete This section is incomplete

Step One

Certified Food Manager Course Registration
- Located at the Office of Emergency Management 4424 US HWY 34 Kewanee, Il 61443
- 8-Hour Course- $140.00
- No refunds will be provided.
- If you are unable to make the class, you must call prior to that class date, to be able to re-schedule to the next available class before June 17th.
- A textbook is not required but HIGHLY encouraged. If you are new to food safety our office recommends you to purchase a textbook and look over the topics before class. It can be purchased through our office for $50.00.
- Please bring to class: Current photo ID, Highlighter, Pencil, Pen, Notebook (to take notes)
- Seat not secured until payment has been received by the office
Select class you would like to attend*
1. July 10th 8:30-4pm & July 11th 9am-1pm
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Demographics

First Name*
Last Name*
Phone Number*
E-mail address*
Address*
City*
State*
Zip Code*
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Employment Information

Place of Employment*
Phone Number*
Employment Address*
City*
Zip*
Position *
Dates of Course Requested*
1. July 10th & July 11th
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Payments

Please Select *
1. 8-Hour Course & Exam - NO BOOK $140
2. Text Book $50
3. Exam Retake $40
Please submit the fee along with the registration form. Payments can me made online or in person. Checks made payable to:
Henry County Health Department
110 N Burr Blvd.
Kewanee, Il 61443
Registration form and fee must be received ONE MONTH before the start date. Please return this registration form with your fee as soon as possible as enrollment for the course is limited to 55 students.
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Signature

Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*
Date*
Date

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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Environmental Health

PROGRAMS

Food Protection Program

Private Sewage Disposal

Wells

Indoor Air Quality

Solid Waste and Nuisance Complaints

MAKE AN ENVIRONMENTAL HEALTH PAYMENT

Certified Food Manager Course Registration

Steps

Step One

Demographics

Employment Information

Payments

Signature

Contact Us

Environmental Health

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