information request form - alberta health services · web viewrequest for environmental public...

Provide the information below to request EPH records. Please note that select orders and restaurant inspections are available on the AHS EPH website. Email or fax the request to the office location listed below that is closest to the property. If you would like to mail your request, please find the mailing address on the EPH Contact Map.

Applicant Information – this document is fillable, click on the lines to enter information

Name: Email:

Request for Environmental Public Health Information 

Phone Number:

Alternate Phone Number: Address:

Business Information, if applicableBusiness Name: Business Phone Number: Business Fax Number: Business Address:

Details of Request

☐ Inspection Report☐ Record Search☐ Other

Facility name, street address/legal land description, info request & reason

Date range of records requested Until ☐Last inspection report

Edmonton and Area Ph: 780-735-1800 Fax: 780-735-1802 ahs.ez.eph.recordsearch@albertahealthservices.ca

Calgary and Area Ph: 1-855-943-2288 Fax: 403-943-8056 ahs.cz.eph.recordsearch@albertahealthservices.ca

Southern Alberta Ph: 403-388-6689 Fax: 403-328-5934 ahs.sz.eph.recordsearch@albertahealthservices.ca

Northern Alberta Ph: 780-791-6078 Fax: 780-714-5620 ahs.nz.eph.recordsearch@albertahealthservices.ca

Central Alberta Ph: 1-877-360-6366 Fax: 403-356-6433 ahs.cnz.eph.recordsearch@albertahealthservices.ca

Signature: Date: __________________

EPHAdmin-13-002Created: Dec/13Updated: Mar/14