2. Environmental Health General Complaint Form
6. Public Record
   All correspondence with the Environmental Health division of the Craven County Health Department is subject to North Carolina public record law in accordance with NC G.S. 132. Correspondence includes, but is not limited to, email and complaint forms.
10. Complainant Information
12. Date:*
    Date:
14. **To remain ANONYMOUS, fill in N/A for Name, Phone Number, & Email Address.**
16. Name:
17. Phone Number:
18. Email Address:
20. Type of Complaint:*
    -- Select One --Body ArtChildcare FacilityRestaurant, Hotel or Nursing HomeSeptic Tank SystemSwimming Pools & SpasOther
22. If other type of complaint, please specify:
26. Complaint Location & Information
28. Owner Name (if applicable):
30. Establishment Name (if applicable):
32. Address of Complaint:*
34. City:*
35. State:*
36. Zip Code:*
38. Complaint Details:*
40. Would you like to be contacted by the Health Department regarding this complaint?*
    -- Select One --YesNo
42. If you would like us to contact you, please provide your email or phone number below.
44. Email:
45. Phone number:
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field