Share Share

SMOKING COMPLAINT FORM

Date of Complaint:
 
Time of Violation:
 
Location of Violation:
 
Name of Establishment:
 
Establishment Address:
 
Establishment Phone Number:
 
Type of Smoking Violation(s):
...
Smoking within 25 feet of an entrance, exit and wheel chair ramp.
...
Smoking being permitted in a no smoking area.
...
“No Smoking” signs are not posted.
...
Ashtrays present in non smoking area and/or within 25 of an entrance, exit, or wheel chair ramp.
...
Smoking infiltrating neighboring property.
...
Other (please explain below)
 
 
Your Name:
 
Your E-Mail:
 

For further assistance contact 832.393.5750.