Environmental Health Complaint Form

Environmental Health Complaint Form
Please note: Lincoln County Health Department does not follow up on health hazard complaints in the City of Merrill, City of Tomahawk or nuisance complaints in the Town of Merrill. Septic issues should be sent to the Lincoln County Zoning Department.

Filing a complaint, request, or report will create a public record that is subject to disclosure pursuant to Wisconsin public record law.
Today’s Date*

MonthDayYear
Date
What type of complaint do you wish to file:*

Health HazardLicensing (example: restaurant, hotel, etc.)

Licensing Complaint

Name and contact information optional. If you wish to be notified of the results, please provide contact information.
I would like to be notified of the results (if yes, fill out contact information) (if no, simply skip over and hit "next").
Your Name:
Your Phone Number:
Please enter a valid phone number.
Your Email:
example@example.com

Complaint
Owner’s Name:*
Owner’s Phone Number:
Address (Location of Complaint):*
Detailed Description of Complaint:
Do you wish to be notified about the investigation results?

YesNo
If you are submitting a Health Hazard complaint, a signature is required to state that you are filing a complaint.
Signature

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Health Hazard Complaint