EHHD Complaint Form

4 South Eagleville Road, Mansfield, CT 06268 - Tel 860.429.3325 - Fax 860.429.3321 - www.ehhd.org

New Complaint

To report a complaint or concern about a public health nuisance or suspected Code violation, you can call or write to the health district, or you can use this on-line complaint form.

Please enter the information about your complaint below. You may choose to enter the complaint anonymously by simply not filling in the lower portion of the form. However, if you choose not to provide a contact telephone number, you must provide enough details about your complaint to help us locate and investigate the nuisance condition.

Address of the Complaint*

Street Address

Street Address Line 2

CityState

Zip Code

Complaint (Description)*

Your Information (optional)

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Email

example@example.com