Mass Gathering Application

FORM – English

Required Contact Information

APPLICATION FOR MASS GATHERING PERMIT

Property Owner Information

Site Clean Up Plan

Plan for Directional Exit Signs

Plan of address Nuisances or Health Hazards Associated with Animals Present at the Gathering

Total Number of Emergency Medical Personnel Qualifications

*You must submit a site plan describing the area where the gathering is to be held, including all of the following:

The parking area available for patrons
Location of entrance, exit, and interior roadways and walks
Location of all first-aid stations and emergency medical resources
Location, type, and provider of restroom and hand washing facilities
Location and description of water stations
Location and number of food stands, and the types of food to be served if known (food vendors will require separate permits)
Location, number, type, and provider of solid waste containers
Location of operator's headquarters at the gathering
A plan to provide lighting adequate to ensure the comfort and safety of attendees and staff
Location of all parking areas designated for the gathering and under the operator's control

*Please provide copies of all service agreements for the event (i.e., liquid waste, solid waste, emergency medical services, site use orrental, etc.)

Max File Size: 2MB

Or for larger files provide a public link to DropBox, or GoogleDrive, so that we can download your files:

Digital Signature

By typing your name below, you are signing this form electronically. You agree to, and understand, all the information you are submitting:

Click the SEND button only once. It will take just a moment to process your information. You will receive a confirmation email if your submission was successful.

CLIENT GRIEVANCE PROCEDURE

Clients of the Bear River Health Department (BRHD), have the right to file a grievance for any action or inaction of the Department and/or Department employees as outlined in Utah Code 26A-1-121 Section 2.

A client may request an administrative review (grievance hearing) at any time during participation in a BRHD service or program. This right is explained to clients during initial enrollment in services. Clients have the right to review his or her file, a right to a copy of any contracts or treatment plans, and the right to ask questions regarding agency policies and procedures.

The following steps will be taken if a client voices a complaint regarding a BRHD program, policies, procedures, or staff member:

All interactions with a client regarding any complaint or grievance must be documented, either in the client file or in the case of a non-client on an Incident Report form.
The staff member taking the complaint will ask the client if they have attempted to resolve the situation with the BRHD employee familiar with the circumstances surrounding the complaint.
If the issue cannot be resolved directly between the client and BRHD staff involved, the client may speak to the Division Director with oversight for the program in question.
If the issue cannot be resolved between the client and the Division Director, the client will be referred to the Administration office to speak with the BRHD Director or Deputy Director.
If resolution still has not occurred, the client may request an adjudicative hearing with the Board of Health.

A client will not suffer any repercussion in service delivery solely as a result of filing a grievance. All grievances will be addressed in a confidential manner. If a grievance is being submitted in written form, it should be mailed or delivered in person to:

Bear River Health Department
Administration Division
655 East 1300 North
Logan, UT 84341

Utah Code: 26A-1-121 Section 2a. A person aggrieved by an action or inaction of the local health department relating to the public health shall have an opportunity for a hearing with the local health officer or a designated representative of the health department. The board shall grant a subsequent hearing to the person upon the person’s written request. 2b. In an adjudicative hearing, a member of the board or the hearing officer may administer oaths, examine witnesses, and issue notice of the hearings or subpoenas in the name of the board requiring the testimony of witnesses and production of evidence relevant to a matter in a hearing. The local health department shall make a written record of the hearing, including findings of facts and conclusions of law.

Updated May 2017

Smoking Vehicles

Are vehicles allowed to smoke?

A gasoline-powered motor vehicle may not emit visible contaminants during operation, except while the engine is being warmed to the recommended operating temperature.
A diesel engine manufactured on or after January 1, 2008, may not emit visible contaminants during operation, except while the engine is being warmed to the recommended operating temperature or under a heavy tow, or unless the diesel engine is in a vehicle with a manufacturer’s gross vehicle weight rating in excess of 26,000 pounds.
A diesel engine manufactured before January 1, 2008, may not emit visible contaminants of a shade or density that obscures a contrasting background by more than 20%, for more than five consecutive seconds, except while the engine is being warmed to the recommended operating temperature or under a heavy tow, or unless the diesel engine is in a vehicle with a manufacturer’s gross vehicle weight rating in excess of 26,000 pounds.

How do I report a smoking vehicle?
Call the statewide smoking vehicle hotline at 385-GOT-SMOG (385-468-7664).”

How to chlorinate your well/spring:

Locate well casing or collection box.
Add ½ gallon of household bleach to shallow well or collection box; or 1 gallon to deep well (over 100’ deep). Measurements may vary depending on size and depth of well.
If possible, use garden hose attached to outside faucet, (same water system). Place hose 2’ into well casing and turn on water. This is to re-circulate the chlorinated water. Do this for about 1 hour. If you can not use a hose –mix the bleach in 5 gallons of water and poor into well.
Remove the hose and replace lid with sanitary seal. Check for cracks. Turn off outside hose.
Go into home and turn on all faucets until you smell chlorine.
Turn off faucets and allow chlorine to sit in lines for a minimum of 8 hours which is contact time to kill bacteria.
After contact time, Flush out chlorine, THOROUGHLY by running water for 3-4 hours onto the grass. DO NOT run through the house into the septic system. Then turn on home faucets for 5 to 10 minutes allowing chlorine to flush out of the faucets. Cautions: Not completely flushing out chlorine may cause health effects or bleach out laundry.
Wait 4 days and re-test water.

How to take a water sample:

Pick up a free sterile water sampling bottle from the health department.
Let water run at least 3-5 minutes before taking the sample, preferably through a non-filtered spigot or tap (bathtub faucet). If taking an outdoor sample, take it from the spigot or valve (not the hose).
Fill the sample bottle exactly to the 100 mL mark on the bottle, be careful not to contaminate the lid or inside the bottle.
Close the bottle securely, and bring it in to the Health Department as soon as possible. (sample need to be run within 24 hours) Please keep the sample refrigerated or surrounded by ice until sample is dropped off.
Drop off sample at 85 E 1800 N Logan Monday through Thursday between 8am and 4:30pm. You can drop off at Brigham City and Tremonton locations as well.
Samples will be read 24 hours from sample reading. Due to the number of sample run, only positive (dirty) samples will receive a phone call. All other samples will be notified by mail within a couple of weeks.

Do Not Use Autofill Options

We all love our “Autofill” or “Autocomplete” — However, your form will not submit successfully if you use it. Please, do not autofill or autocomplete any text field if you intend for us to receive your form. Thanks!

I understand, I will not autofill.