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Nebraska DHHS: SmokeFree Nebraska: Reporting / Complaint Form




Reporting / Complaint Form
Smoke Free Nebraska.  So long smoke.  Hello clean air.
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.
Select your language(elige tu idioma):



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
For more information, contact:
Toll-Free: 1-877-633-7331
E-mail: SmokeFree Info
Good Life. Great Mission.