The Offsite Event Notification Form is the Sacramento County Environmental Management Department (EMD) form that a participating facility completes to notify the Medical Waste Program of a temporary offsite event, such as a vaccine clinic, blood drive, stand down event or health fair. It records the event, the participating facility and a signed self-declaration that the information is complete and correct. You can fill out the form online on FillingPDF and download or print the completed PDF; the county publishes the original, and the completed form goes to the Medical Waste Program by fax or mail, as described below.
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What is Offsite Event Notification Form – Sacramento County, CA?
The Offsite Event Notification Form is the notice a facility files with the Sacramento County Environmental Management Department (EMD), Environmental Health Division, to report a temporary offsite event, such as a vaccine clinic, blood drive, stand down event or health fair.
The form is a notification, as its title says, and it prints no license or permit. It has three blocks to complete. Event Information asks for the event name, address, phone, contact person, event type and event date(s). Participating Facility Information asks for the facility name, address, phone and contact person. The Signature block holds a self-declaration that the information is complete and correct to the best of your knowledge, followed by a signature and date.
A fee block explains that a notification fee applies to temporary offsite events. The facility receives a separate bill for it, and no payment goes in with the form. The form's printed instructions say to fill out only the white portions: the gray portions are completed by EMD staff. The form is handled by the EMD Medical Waste Program, and the revision date printed on it is 12/9/14.
Who needs to file Offsite Event Notification Form – Sacramento County, CA?
The form is addressed to a facility that takes part in a temporary offsite event. Its instructions speak to "your facility": the facility is billed separately for the notification, keeps a copy of the completed form and makes it available to regulatory personnel during routine inspections.
The event types printed on the form show the situations it covers:
- Vaccine Clinic
- Blood Drive
- Stand Down Event
- Health Fair
- Other, with a line to describe the event
The form does not say who within the facility must sign it. It does ask for a contact person for the event and a contact person for the facility, which may be different people. It does not describe exclusions or representatives. If you are unsure whether your event or facility falls under this notification, or need help completing it, the instructions give the Medical Waste Program staff line at (916) 875-8440.
When to file Offsite Event Notification Form – Sacramento County, CA
Submit the form when a facility is taking part in a temporary offsite event, since the form is the notification for that event and asks you to list the event date(s). The form prints no separate due date or advance-notice period, so there is no deadline to quote here. Because each notification is tied to an event and its dates, expect to complete a form for each event. For questions about timing or about what the Medical Waste Program needs for your event, call (916) 875-8440, the number the instructions give for help with the form.
How to fill out Offsite Event Notification Form – Sacramento County, CA
Fill out only the white portions
Complete the white fields of the form. Leave the gray portions blank, because EMD staff fill them in.
Enter the event name and location
Under Event Information, enter the Event Name, the Address of the event, the Phone number and the Contact Person for the event.
Mark the event type
Check the box that matches your event: Vaccine Clinic, Blood Drive, Stand Down Event or Health Fair. For any other event, use the Other line to describe it.
Enter the event dates
Write the Event Date(s) on the line provided.
Enter the participating facility details
Under Participating Facility Information, enter the Facility Name, Address, Phone and Contact Person.
Read the fee notice
The filing fee block explains that the facility is billed separately for the notification. Do not enter payment information or send payment with the form.
Sign and date the self-declaration
Sign and date under the Self-Declaration, which certifies that the information is complete and correct to the best of your knowledge.
Review, download and keep a copy
Check every white field, then download or print the completed PDF from FillingPDF. Keep a copy for your records and send the form as described under How to submit.
How to submit Offsite Event Notification Form – Sacramento County, CA
You can submit the completed form to the EMD Medical Waste Program by fax or by mail.
- Fax: (916) 875-8513, Attn: Medical Waste Program.
- Mail: Environmental Management Department, Medical Waste Program, 11080 White Rock Road, Rancho Cordova, CA 95670.
Do not send payment with the form. The notification fee for temporary offsite events is billed separately to your facility; the form does not print the amount, so ask the Medical Waste Program at (916) 875-8440. Keep a copy of the completed form for your records and make it available to regulatory personnel during your facility's routine inspections. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Filling in the gray portions of the form; the instructions say EMD staff complete them and applicants fill out only the white portions.
- Sending payment with the notification; the form says not to remit payment because the facility is billed separately.
- Faxing the form without "Attn: Medical Waste Program" or mailing it to the department without the Medical Waste Program line.
- Skipping the copy for your records; the instructions require you to keep one and make it available during routine inspections.
- Leaving the self-declaration unsigned or undated, so the certification that the information is complete and correct is not made.
- Treating the form as a business license application; it is a notification of a temporary offsite event and prints no license.
Frequently asked questions
What is the Offsite Event Notification Form?
It is a Sacramento County Environmental Management Department form that a facility uses to notify the Medical Waste Program of a temporary offsite event. It records the event, the participating facility and a signed self-declaration that the information is complete and correct to the best of your knowledge.
Is the Offsite Event Notification Form a Sacramento County business license?
No. The form is a notification: it collects event and facility details plus a self-declaration, and the county bills a notification fee for temporary offsite events. It prints no license or permit. For questions about the form, call the Medical Waste Program at (916) 875-8440.
Where do I send the Offsite Event Notification Form?
Fax it to (916) 875-8513, Attn: Medical Waste Program, or mail it to Environmental Management Department, Medical Waste Program, 11080 White Rock Road, Rancho Cordova, CA 95670. The form names no other channel.
Do I pay when I submit the Offsite Event Notification Form?
No. Do not send payment with the form. It states that a notification fee applies to temporary offsite events and that your facility will receive a separate bill. For the current amount, call the Medical Waste Program at (916) 875-8440.
What kinds of events does the form cover?
The form lists Vaccine Clinic, Blood Drive, Stand Down Event and Health Fair as event types and has an Other line for anything else. You also enter the event name, address, phone, contact person and event date(s).
Which parts of the form do I fill out?
Fill out only the white portions: Event Information, Participating Facility Information and the Signature block. The gray portions are completed by EMD staff, so leave them blank.
Do I need to keep a copy of the completed form?
Yes. The instructions say to keep a copy of the completed notification form for your records and to make it available for review by regulatory personnel during your facility's routine inspections.
Can I fill out the Offsite Event Notification Form online?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service and does not send the form to the county; you fax or mail it to the Medical Waste Program yourself.
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