Clean Indoor Air & Tobacco Violation Report Form
Use this form to report violations to Colorado's Clean Indoor Air Act. Responses will be reviewed by staff of the Colorado Department of Public Health and Environment's Tobacco Program and forwarded to the appropriate local public health agency for a follow-up. 
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Today's Date *
Datum
In what city and county did the incident occur? *
What type of complaint is this? *
Please describe the incident. *
Where did the incident occur? *
When did the incident occur? *
Datum
Please provide the name and address of the location where the incident occurred (if applicable). *
Your first name:
Your last name:
Email: *
Phone number:
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