DHHS Internet Website - Public Health

Nebraska Clean Indoor Air Act Complaint Form

Please use this form to report any observed smoking in an indoor public place or place of employment. All complaints will be investigated.

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 activitity, i.e.: ashtrays?
Other details:
Your name:
Anonymous
Your phone:
Your e-mail address:

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* Required