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Division of Environmental Health Food Safety and Sanitation Program

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Forms

If you need assistance filling out a food or a public facility form or have a question, please contact an Environmental Health Officer in your area.

If you need assistance filling out a seafood or a shellfish form, contact our Anchorage office at 907-269-7501.

Date Title and Document Download Category Program Description Folder ID
8/17/2018 Seafood Permit Variance (PDF 47K) Forms Seafood forms-seafood-permit-variance.pdf (PDF 47K)
8/17/2018 Seafood Processing Facility Agreement (PDF 153K) Forms Seafood, Shellfish forms-seafood-shellfish-processing-facility-agreement.pdf (PDF 153K)
8/17/2018 Variance for Seafood Source (PDF 96K) Forms Seafood, Food food forms-seafood-source-variance.pdf (PDF 96K)
1/7/2020 Waiver for Seafood Product Testing (PDF 189K) Forms Seafood forms-seafood-Waiver-rte-sampling.pdf (PDF 189K)
8/17/2018 Shellfish Harvesters Application (PDF 322K) Forms Shellfish forms-shellfish-harvesters-application.pdf (PDF 322K)
8/17/2018 Geoduck Dive Vessel Application (PDF 309K) Forms Shellfish forms-shellfish-geoduck-dive-vessel-application.pdf (PDF 309K)
8/17/2018 Shellfish Dealer Application (PDF 318K) Forms Shellfish forms-shellfish-application.pdf (PDF 318K)
8/17/2018 Shellfish Export Certificate Application (PDF 34K) Forms Shellfish forms-shellfish-export-certificate-application.pdf (PDF 34K)
8/17/2018 Shellfish NOAA Export Certificate (PDF 489K) Forms Shellfish forms-shellfish-national-oceanic-and-atmospheric-administration-export-certificate.pdf (PDF 489K)
8/17/2018 Public Facility Application (PDF 60K) Forms Public Facilities forms-public-facility-application.pdf (PDF 60K)
8/17/2018 Variance Request (PDF 35K) Forms Food, Public Facilities forms-food-variance-request.pdf (PDF 35K)
8/17/2018 Alaska Food Service Excellence Self-Inspection (PDF 557K) Forms Food food forms-food-state-of-alaska-food-service-excellence-self-inspection.pdf (PDF 557K)
8/17/2018 Alaska Food Service Excellence Self-Assessment (PDF 155K) Forms Food food forms-food-state-of-alaska-food-service-excellence-self-assessment.pdf (PDF 155K)
8/17/2018 Alaska Food Service Excellence Application (PDF 116K) Forms Food food forms-food-state-of-alaska-food-service-excellence-application.pdf (PDF 116K)
8/17/2018 Food Establishment Plan Review Supplement (PDF 774K) Forms Food Food forms-food-food-establishment-plan-review-supplement.pdf (PDF 774K)
8/17/2018 Food Plan Review Application (PDF 165K) Forms Food Food forms-food-plan-review-application.pdf (PDF 165K)
8/17/2018 Food Establishment Permit Application (PDF 244K) Forms Food Food forms-food-food-establishment-permit-application.pdf (PDF 244K)
8/17/2018 Food Commissary Agreement (PDF 229K) Forms Food Food forms-food-commissary-agreement.pdf (PDF 229K)
8/17/2018 Food Establishment Inspection (PDF 99K) Forms Food Food forms-food-food-establishment-inspection.pdf (PDF 99K)
3/23/2021 Seafood Plan Review Checklist (PDF 413K) Forms Seafood forms-seafood-plan-review-checklist (PDF 413K)
5/5/2023 Approved Kitchen Letter of Agreement (PDF 197K) Food forms-letter-agreement-approved-kitchen (PDF 197K)

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Department of Environmental Conservation

Mailing Address:  P.O. Box 111800
Juneau, Alaska 99811
Location:  410 Willoughby Avenue, Juneau