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Local Health Officer Training

Section 8: Conclusion Course Review and Evaluation

Congratulations

Congratulations on completing the Core LHO training. Thanks for being a part of a proud tradition of local public health services that begain in 1885.

Instructions: Please complete the entire form below before you exit this site to receive the mandatory 6 credit hours of training. After entering your information, check the certification box at the end of this form, then click on the SUBMIT button. Your certificate of completion will appear in a new window. You can print or save the document. This is your proof that you have met the statutory training requirements.

Important: All LHOs must submit their signed Letter of Appointment within 15 working days from the date of appointment. However, if you have not yet submitted your official Letter of Appointment, please send a copy of the letter within 5 working days of the completion of this training by mail to:

Maine Center for Disease Control and Prevention
286 Water Street, 7th Floor, SHS 11
Augusta, Maine 04333
or Fax to –207-287-5536

LHO Online Training Completion Form

*Name:

*E-Mail:

Town Appointed:

Were you officially appointed by your Town?: Yes No

If no, please tell us when we can expect confirmation of your appointment (mm/yyyy) :

*Town/City of LHO Assignment:

Date of Appointment:

*Mailing Address:

*City:

County:

*State:

*ZIP Code:

*Day Time Phone:

Cell Phone:

FAX:

*State Employee:

Are you a state employee?: Yes No

Other Roles:

Are you employed by your town government in another role (other than the LHO)?: Yes No

If yes, please check all that apply:
animal control officer	code enforcement officer	Town clerk
fire department	nurse	Registrar of Voters
paramedic	plumbing inspector	town treasurer
town manager	select person	Other

Feedback and Comments on this Training:

I certify that I have completed this Local Health Officer Core Training and understand the subject matter contained in this training. In the event questions arise during my performance as the town's LHO, I can contact the Maine Center for Disease Control and Prevention, State Local Health Officer Program Coordinator for assistance.

Congratulations on finishing the training!

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