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Office of Health Assurance and Licensing - EALS User Account Request
The below information is required to obtain secure access to Environmental Abatement & Licensing System (EALS). By submitting this request, you swear or affirm that you are authorized to perform business processes related to the ODH licensed professional below.
First Name:*
Last Name:*
e-mail Address:*
Secondary Contact Name:

Reason for request (at least one reason is required):*

Technical Issue Description:*

License Information: (at least one selection required):*
(To enter multiple licenses separate them by comma ",". e.g. AC0000,AC9999,AC7878)
    ODH License Number:  (e.g. LC000000)
Or Licensee Last Name: 
    ODH License Number:  (e.g. LA989898)
Or Licensee Last Name: 
    ODH License Number:  (e.g. LI000000)
Or Licensee Last Name: 
    ODH License Number:  (e.g. TL000)
Or License Name/Entity: 
    ODH License Number:  (e.g. CT000000)   
Or License Name/Entity: 

I swear or affirm that the information provided herein, and any attachments hereto, have been prepared or carefully reviewed by me and constitute a truthful and correct disclosure of all information herein. I certify that the undersigned is the operator (if the operator is an individual), the president or other officer (if the operator is a corporation), a partner (if the operator is a partner), or an authorized agent of the operator.

If you have a question regarding use of this form e-mail us at liccert@odh.ohio.gov.

* = Required field
Enhanced Information Dissemination Version 4.0.3
Software release on: 11/16/2022 6:40pm