COVID-19 Responsible Restart Ohio Complaint Intake Form

COVID-19 Responsible Restart Ohio Complaint Intake Form
Business Information
Business Name *
Business Address *

Street Address

Street Address Line 2

City

Postal / Zip Code
Business Phone Number

Area Code Phone Number
Type of Business: *
Type of Health Care: *
Type of Personal Service: *
Nature of Complaint (click all the apply) *

Facial Coverings/Masks (employers/employees only) Prohibited Activities Social Distancing Requirements Hand Sanitizer and Sanitizing Products
Nature of Complaint *
Business Contact Name (if applicable)

First Name Last Name
Business Email
example@example.com
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Your (Complainant) Information

While it's not necessary to leave your information, it would aid our investigation if we have follow-up questions or need more information.
Submitter Name

First Name Last Name
Submitter Phone Number

Area Code Phone Number
Submitter Email
example@example.com
Additional Comments

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