Complaint Form

Please fill out this online complaint form for any concerns dealing with public health violations.

Complaint Form

Please indicate the nature of the complaint to be investigated (i.e. pest issue, cleanliness issue)

Location (be specific): *

Name - Person(s) Responsible for the Condition: *

Address - Person(s) Responsible for the Condition: *

Phone - Person(s) Responsible for the Condition: *

Name - Owner of Property (if different):

Address - Owner of Property (if different):

Phone - Owner of Property (if different):

How long has the condition existed? *

Have you reported this condition to the person(s) responsible? *

Yes

When?

Was this condition reported to another agency?

What Agency?

By making this request for an investigation, I acknowledge that the health department may take all necessary steps consistent with the appropriate laws to investigate and effect correction if such is warranted. Such action may involve referral to other agencies or legal action that may require the need for court appearance and testimony to collaborate the conditions stated in this complaint. *

Yes

Name - Person requesting the investigation

Address - Person requesting the investigation:

Phone - Person requesting the investigation:

Email - Person requesting the investigation:

Todays Date

Thanks for submitting!