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Environmental Health Complaint Form
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* Indicates required question
Date of Incident
*
MM
/
DD
/
YYYY
Complainant's Name (optional):
Your answer
Email:
Your answer
Phone:
Your answer
Complaint Type
*
Restaurant
Lodging
Commercial Swimming pool
Childcare
Tattoo
Name of Establishment:
*
Your answer
Address of Establishment
*
Your answer
Complaint Details:
*
Your answer
Please be advised, if no contact information is provided and form does not have enough detail, our team will be unable to perform a complaint investigation.
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