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Last Updated: 09/28/11 01:38:18 PM

Nevada Clean Air Indoor Act (Complaint Form)

For filing complaints under the Nevada Clean Air Indoor Act you have three choices. For Southern Nevada use the Southern Nevada Complaint Form , for Washoe County use the Washoe County Smoking Complaint Form ,for all others please complete the form below.

 

Please fill in all fields marked with a *

PERSONAL INFORMATION

 
Last Name*:  First Name*:
 
Address:
 

City: State: Zip:

 
Phone Number*: Email Address:
 

VIOLATION INFORMATION

 
Date Violation Observed*:   Approximate Time Violation Observed:
 

Was a Customer or
Employee Smoking
Yes No

Were No Smoking
Signs Posted
Yes No

Smoking Materials were present
  (ashtrays or matches)
Yes No

 
Name of Establishment*: Establishment County:
 
Establishment Address*:
 
City: State: Zip:
 
Comments:
 
 

 

 
 

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Nevada State Health Division
4150 Technology Way
Carson City NV 89706-2009
Monday - Friday
8 am - 5 pm

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