Public Health Threat Accusation Form
Report and document a public health concern with clear details, location, timing, and supporting information.
Reporter Information
Full Name
*
First Name
Last Name
Contact Email
example@example.com
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Method
*
Email
Phone
No response needed
Threat Accusation Details
Date concern was observed
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location or setting of concern
*
Type of public health concern
*
Unsafe food handling
Contagious illness exposure
Sanitation issue
Water contamination
Air quality issue
Chemical exposure
Other
Detailed description of accusation or observed threat
*
Supporting Information
Supporting Evidence or Documentation
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Urgency Level
*
Low
Moderate
High
Immediate
Submit Form
Should be Empty: