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
*
Disease Report
Animal Bite
Food Illness
Restaurant Complaint
Retail Food-Restaurant/ Market / Bakery
Wholesale Food
Illegal Food Vending
Housing-Apartment/Condo
Housing-Single Family Dwelling
Housing-Other
Alley/Street/Lot
Swimming Pool
Sewage
Universal Studios Communities Noise Complaint
Other
Date and Time of Incident
*
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Month
-
Day
Year
Date Picker Icon
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Name of Location
*
Description of 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
Day Phone Number
*
-
Area Code
Phone Number
Evening Phone Number
-
Area Code
Phone Number
Fax Phone
-
Area Code
Phone Number
E-mail
Mail Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please contact me by:
Phone
Email
Fax
Mail
What is the best time to contact you?
SUBMIT
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