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
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
Drag and drop files here
Choose a file
Cancel
of
Name of Business or Individual (if known)
Additional Comments
Your Name (optional)
Your Email or Phone (optional, for follow-up)
Submit Report
Should be Empty: