Submit an Inquiry

Fields marked with an asterisk (*) are required.

COVID related concern:

Employee not wearing mask
No social distancing
Customers not wearing mask

High touch surfaces not cleaned
Bathroom not open
Hand sanitizer not available

Other
Customers not being screened (minimum: screening poster)
Bartender/customer not separated if bar open

I wish to submit a: Question Complaint Need

Date and time of complaint occurrence:

:

First Name:

Last Name:

Phone Number:

Email Address:

Are you a Business? Yes No

Do you hold a license with a state agency?

Business Name

Business Address

City

Zip Code

State

Did you visit this business? Yes No