EH complaint form
Please complete all fields below and click on the SUBMIT button to send your complaint. Staff will address your concerns as soon as possible and you will be contacted with the results of our investigation. Please be aware that an adult (over 18 years) has to be available for contact. All complaints are confidential. Although anonymous reports are accepted, we request your contact information so that we may contact you if we need additional information to properly address your complaint. Also, if you do not leave your contact information, we will not be able to inform you of our actions.
Type of of Incident/Problem
*
Food Service - Restaurant Complaint
Food Poisoning - Refer to other complaint form
Illegal Food Vending
Swimming Pool (Public)
Sewage Disposal
Tattoo Violations
Smoke Free Air (smoking complaints)
Unihabitable Premises
Hazardous Waste - Spills/Storage/Disposal
Garbage/Refuse
Rodents/Insects
Other
Date and Time of the Incident
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Name and/or Location
*
Description of the Incident/Problem
*
Does this problem still exist?
Yes
No
Don't Know
Is the problem intermittent or constantly occurring?
Intermittent
Constantly Occurring
Not Sure
Your Title (Mr. Mrs. Ms. Dr.)
Full Name
*
First Name
Last Name
Primary Phone Number
*
Secondary Phone Number
Fax Number
E-mail
example@example.com
Mail Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County
Your preferred contact method:
Phone
E-mail
Fax
Mail
What is the best time to contact you?
SUBMIT
Should be Empty: