Clean Indoor Air Act Complaint Form

 
7
 
Public Health
 
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No

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What you need to know

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Date of the violation: *
Time of the violation:
Facility name: *
Facility address: *
Facility city or town: *
Where in the building was the smoking observed?
Was there other evidence of smoking activity, i.e.: ashtrays?
Other details:
Your name:
Anonymous
Your phone:
Your e-mail address:


Required