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Fire Code Complaint Form

2. Complaint Form
   Complete this form to submit a fire code or life safety complaint to the Fire Marshal.

   Complete this form to submit a fire code or life safety complaint to the Fire Marshal.

4. First Name

5. Last Name

7. Contact Number*

   Please provide a contact number so we may contact you if more information is needed

8. Home*

   1. Home
   2. Work
   3. Cell

9. Best time to contact*

   1. 6:00am - 9:00am
   2. 9:00am - noon
   3. Noon - 1:00pm
   4. 1:00pm - 5:00pm
   5. 5:00pm - 9:00pm

11. Location of Complaint*

    Provide the name of business

12. Date of Violation*
    Date of Violation

    Date of Violation

14. Address1

16. Address2

18. City

19. State

20. Zip

22. List the violations*
    -- Select One --Locked exit doorsOvercrowdingParking in fire lanesOperating without permitsDefective exit signsOutdoor burningBBQ grill on balconyFireworksElectrical problemsFire Alarm or Sprinkler ProblemsFire Extinguisher ProblemsOther - Please explain

24. Describe the violation*

26. Did you witness the violation?*

    1. Yes
    2. No

27. Uplaod a Photo of the violation

29. Did you contact management?*

    1. Yes
    2. No

31. Thank you for submitting this complaint. Personnel will be assigned to investigate.

    Thank you for submitting this complaint. Personnel will be assigned to investigate.

Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field