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Environmental Health Complaint Form

  1. Information of Person Submitting Complaint

    We require that certain information is submitted with a complaint for tracking and documentation purposes.

  2. Please submit your name so that we may follow up if any further information is needed.

  3. Please provide the best number for us to reach you at.

  4. Please provide your email in event we may need to contact you.

  5. Complaint Details

    Please provide as much detail as possible regarding the complaint you are submitting.

  6. Category of Complaint*

    Please select the category that most closely fits the nature of the issue.

  7. Please estimate the start date and end time of the complaint with as much accuracy as possible.

  8. Please provide an address, major intersection, company name, to help us identify the location of the issue.

  9. Please provide information regarding the complaint.

  10. Clear Creek black

  11. ** Disclaimer **

    Please note that complaints are addressed and investigated in order of severity. Not all complaints lead to legal action. Follow up with the complainant is not guaranteed.

  12. Leave This Blank:

  13. This field is not part of the form submission.