Submit a Complaint

Date Complaint Observed

Establishment Name

Establishment Address

Room/Apartment/Lot Number

Please describe the incident:

Upload a photo of the incident

Optional

Optional Contact Information

If the complaint is of illness, please submit your name and daytime phone number so a Department representative can contact you for more information. If you choose to provide your contact information, it may appear on public records associated with the complaint.

First Name

Last Name

Phone Number