Use this form to submit your LHD Activity Checklist data to CDPH by uploading completed, electronically filled PDF files in the "file upload" section below.
*Only submit checklists with electronically filled data using this form. Do not submit forms that have been filled in by hand and scanned.*
There is a maximum of 10 file uploads with each form. If you need to submit more than 10 LHD Activity Checklists, return to this form to submit your additional checklists.