EH Complaint Form

Name of Reporting Party * (required)

Contact Information

Email * (required)

Phone Number * (required)

Address

What is the nature of the complaint?

• Food Related Illness
• Food Facility
• Public Pool or Spa
• Tattoos and Body Art
• Sewage
• Water and Well Drilling
• Solid Waste
• Hazardous Waste
• Other

Date Violation was Observed? * (required)Date Violation was Observed? * (required)

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Facility Name or Property Address * (required)

GPS Coordinates of Violation

Description of Violation * (required)

Photos or Documentation

Type the characters you see in the image below * (Required)

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Complainant confidentiality is mandatory for the Environmental Health Division. Environmental Health may not release complainant information when conducting investigations. Additionally, complainant information is always redacted when copies of the complaints and/or reports are requested through a Public Records Act (PRA) request.

The benefits to providing the requested complainant information include the following:

• Receive the results of the investigation (if requested)
• Be able to be contacted by the investigating officer if additional details of the complaint are needed to successfully investigate the complaint and provide important safety information to the investigating officer.
• Receive educational information about Mendocino County Code (MCC) if the complaint is determined to be unfounded.
• Receive additional informational resources, if needed.