Environmental Health

PROGRAMS

Food Protection Program

Temporary Food Events
Food Establishments
Food Establishment Inspections
Foodborne Illnesses
Farmers Markets
Cottage Food

Septic & Water Well Inspections
Zoning Requests (Plot Surveys)
Registered Septic Contractors, Pumpers & Portable Sanitation
Contractors Registration Forms & Private Sewage Disposal System Applications
Henry & Stark County Private Sewage Disposal Ordinances & IDPH Codes

Wells

Well Forms for Contractors
Well Sealing Forms
Closed Loop Well Forms
Henry & Stark Water Ordinances and IDPH 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.
- 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. August 19th 8:30am-4pm & August 20th 9am-1pm
2. October 28th 8:30am-4pm & October 29th 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. August 19th 8:30am-4pm & August 20th 9am-1pm
2. October 28th 8:30am-4pm & October 29th 9am-1pm
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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 30 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

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Environmental Health

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