Environmental Health Complaint Referral Form

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The Environmental Health Division regularly investigates County resident reports or complaints of public health hazards and nuisances throughout Chautauqua County. If you wish to file a complaint, please fill in the following information.

Tell us about yourself:

Chautauqua County Health Department will not disclose your name and contact information, but this information is required to submit a complaint. Incomplete or fictitious submissions will not be investigated.

Name

Telephone Number

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email (Optional)

Tell us about your complaint:

Nature of Complaint

Upload a photo or supporting document

Unlimited number of files can be uploaded to this field.
100 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Location of complaint (Business Name/Property Owner)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

8/2023

Environmental Health Complaint Referral Form

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