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Report an Environmental Health Problem
Report an Environmental Health Problem
Type of Report
*
Public Swimming Pool / Whirlpool
Restaurant or Retail Food Establishment
Septic System Issue
Lodging Conditions
Mold
Air Quality Problem
Pests
Unsanitary Living Conditions
Tattoo or Body Piercing Establishment
Date of Incident
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2017
2018
2019
Address of Incident
*
Please describe the incident, including date, time and location.
*
Have you reported this incident before?
*
No
Yes
Contact Information
First Name
*
Last Name
*
Would you like us to contact you about this report?
No, do not contact me.
Yes, by phone.
Yes, by email.
Email Address
Phone
Leave this field blank
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