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2. Complaint Form
   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.
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