Broward County Health Department - Protecting the Health of Our Community since 1936
Environmental Health: Public Nuisance Complaint Submission Form
** Complaints Concerning **
Restaurants, Public Lodging or Apartment Buildings of four or more units
Call Department of Business & Professional Regulation (850) 487-1395
** Complaints Concerning **
Food Markets, Supermarkets or Convenience Stores
Call Department of Agriculture & Consumer services (800) 435-7352

Please Provide As Much of the Information Listed on this Form
* Required Information *

* Incident Date:

Today's
Date:

Complaint Information

* Your Information *

Business Name:

* First Name:

Owner/Contact Name:

* Last Name:
* Nuisance Address:

* Address:
 * Nuisance City:

* City:

State:

 State:

Zip Code:

 Zip Code:

Phone #:

* Phone #:

Occupant:

Your e-Mail Address

Occupant Address:

Occupant City:

Cell Phone:

 Optional

Occupant State:

    

Zip Code:

    

Occupant Phone:

    

* Location of Nuisance *
Example: Back of House Next to Alley 

Please Be Specific

* General Type of Complaint:
* Describe the Nuisance Complaint *
Example: Backyard piled up with garbage
  
Please Be Specific

The Health Department Can Not Investigate Your Complaint
Without Complete Information And a Method to Contact You
Please Provide the Required Information Requested on this Form. 
 Thank You
 

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