

Did you know that restaurants, bars, senior centers, coffee shops, and mobile food carts licensed in Dickinson-Iron County are subject to two unannounced inspections every year? Inspections are focused on identifying risk factors that can cause foodborne illness. Violations are categorized by how likely they are to contribute to a foodborne incident.
Priority violations relate to the highest food safety hazards such as proper cooking and reheating temperatures, cooling procedures, cold and hot-holding temperatures, and proper handwashing techniques.
Priority Foundation violations relate to contributing factors such as staff training, labeling/documentation, availability of proper equipment, and other infrastructure that supports food safety.
Core violations relate to general maintenance of facilities or structures, sanitation, or operating procedures.
Reports indicate conditions and observations at the time of inspection.
Inspection reports are public record, additional reports may be available in person by submitting a Freedom of Information Act Request at the Dickinson or Iron County office.
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file:///C:/Users/barbj/OneDrive/Desktop/Billing%20Request%20PDF%20Fillable%20Form%20BJ.htm
Dickinson-Iron District Health DepartmentBilling RequestDickinson-Iron District Health Department
TO: Finance Department FROM: DATE: RE: Bill for Services Provided

Agency/Business/Client Name: Contact/Responsible Party: Street Address: City: _ State: MI Zip:

Itemized Bill Date of Service (DOS): Date Billed by Finance:
Description of Service |
100% Charge |
Amount Paid on DOS |
Balance |
Amount Waived (discounted) |
Balance to Bill | VFC | MI-VRP | Pt Assist | Full-Pay |
Vaccine, Admin, Etc. |
Charge X Quantity |
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| Total to Bill |
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If Client received borrowed vaccine, ECW charges must be corrected. Complete this section.
Client received borrowed Govt. vaccine and should be billed the Full-Pay charge. Update ECW charge for the following vaccines:
Client received borrowed Private Purchase vaccine and should be billed the VFC, MI-VRP or Grant charge. Update ECW charge for the following vaccines:

If service is provided to an agency/business, list staff names receiving the service(s).
Client Name: ECW#
H: Reference Files/Administrative/Finance Department Forms/Billing Request July 2014
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