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:
*
Title:
*
e-mail Address:
*
Secondary Contact Name:
Reason for request (at least one reason is required):
*
New Account
Change Contact
Update E-mail Address
Reset Password
Technical Issue
Technical Issue Description:
*
License Information: (at least one selection required):
*
(To enter multiple licenses separate them by comma ",". e.g. AC0000,AC9999,AC7878)
Lead Abatement Contractor
ODH License Number:
(e.g. LC000000)
Or Licensee Last Name:
Lead Risk Assessor
ODH License Number:
(e.g. LA989898)
Or Licensee Last Name:
Lead Inspector
ODH License Number:
(e.g. LI000000)
Or Licensee Last Name:
Lead Training Provider
ODH License Number:
(e.g. TL000)
Or License Name/Entity:
Clearance Technician
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.
ODH CONTACT INFORMATION
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