Complaints registered with the Jefferson County Health Department must be in writing and signed by the person filing the complaint.
All complaints must be of Public Health or Environmental concern.
I, __________________________________________ hereby register a complaint with the Jefferson County Health Department regarding the following:
Date: _______________
Name of Owner / Responsible party (if known): ___________________________________
Address / Location and Directions:
.
.
Reason / Concern for Complaint:
.
