Form Center

2. Complete this form to report a public health concern.
   Complaints will be investigated as warranted. The Center for Environmental Health responds to complaints about regulated facilities (like restaurants and public swimming pools) and about other environmental issues which may impact public health (like private septic systems and improper waste disposal).
4. LOCATION OF THE PUBLIC HEALTH CONCERN
6. STREET ADDRESS*
7. TOWN/VILLAGE*
9. PROPERTY IS A:

   1. RESIDENCE
   2. BUSINESS
10. OWNER/RESPONSIBLE PARTY
11. OWNER PHONE
13. Business Name
15. BRIEFLY DESCRIBE THE NATURE OF THE PUBLIC HEALTH CONCERN
17. Please include your name and contact information to ensure the Department of Health is able to investigate your complaint fully. Anonymous complaints may not be actionable.
19. COMPLAINANT NAME
20. COMPLAINANT PHONE
22. COMPLAINANT EMAIL ADDRESS
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field