Tobacco Violation Case Report Form
Report suspected tobacco-related violations by providing essential incident, location, and evidence details.
Type of Violation
*
Please Select
Sale to minors
Smoking in prohibited area
Advertising violation
Illegal product sale
Other
Date and Time of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Incident (Address or Description)
*
Description of Incident
*
Was law enforcement notified?
Yes
No
Upload Evidence (Photo or Document)
Upload a File
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of
Name of Business or Individual (if known)
Additional Comments
Your Name (optional)
Your Email or Phone (optional, for follow-up)
Submit Report
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