Online Form - Public Health Complaint Form

Save Your Progress

You have the ability to save this form and complete it at a later date. An email will be generated and sent to the specified address.

Note: Incomplete forms are kept for a period of 2 day(s), after this time the system will automatically delete your response.

Contact Details

Address

Address of Premise
Issue Detail*
Frequency of Issue*

Please Note

1. Your details will be kept confidential, however the Shire of Capel is subject to the Freedom of Information Act 1992.
2. The responsible department will investigate your complaint in line with our current timeframes identified within our Customer Service Charter.
3. Should further information be required, a member of our Environmental Health team will contact you via phone or email.
4. Should this matter be referred to the Magistrates Court for prosecution. you may be called as a witness.

I acknowledge the above*

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