State of Nevada

         
Nevada State Health Department

        
 

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Last Updated: 01/14/09 11:00:52 AM
Nevada Clean Air Indoor Act (Complaint Form)

For filing complaints under the Nevada Clean Air Indoor Act you have three choices. For Southern Nevada use the Southern Nevada Complaint Form , for Washoe County use the Washoe County Smoking Complaint Form ,for all others please complete the form below.

 

Please fill in all fields marked with a *

PERSONAL INFORMATION
 
Last Name*:  First Name*:
 
Address:
 

City: State: Zip:

 
Phone Number*: Email Address:
 

VIOLATION INFORMATION
 
Date Violation Observed*:   Approximate Time Violation Observed:
 

Was a Customer or
Employee Smoking
Yes No

Were No Smoking
Signs Posted
Yes No

Smoking Materials were present
  (ashtrays or matches)
Yes No
 
Name of Establishment*: Establishment County:
 
Establishment Address*:
 
City: State: Zip:
 
Comments:
 
 

 

 
 
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 Complaints:
 Right Arrow Request Info Form (pdf)
 Right Arrow Clean Air Indoor Act Info
 Right Arrow Clean Air Indoor Act (form)

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Nevada State Health Division
4150 Technology Way
Carson City, NV 89706-2009

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