Smoking Complaint Form

Please fill out this form to report violations of the Nevada Clean Indoor Air Act smoking ban. The Northern Nevada Public Health (NNPH) will follow up on the complaint with the information you provide. Please enter all of the information requested (* = entry required). Including your name and contact information will enable us to contact you if we need additional information to respond to your complaint.

Name of Business:

Business Address:

Business City:

Date of Violation:

Time of Violation:

Health Violation:

Customer smoking indoors

Ashtray present in non-smoking area

Employee smoking

No-smoking sign not posted

Additional Information:

First Name:

Last Name:

Email:

Phone Number:

City:

State:

Zip code (ex.89512):