Public Health Nuisance Complaint Form

Public Health Nuisance Referral Form

Please fill out each section completely and accurately.
PLEASE NOTE:

Due to the lack of regulations specific to mold at the federal, state and local level, Franklin County Public Health is only able to assist in issues where mold impacts multiple units in a multi-Family dwelling, such as an apartment building. Franklin County Public Health cannot respond to complaints at an owner occupied home or a single family/free standing unit.
Please be advised that public health nuisance complaints are public record. Compliant reports are subject to Ohio’s public records laws and can be reviewed or released to any requesting party. Nuisance complaints can be made anonymously. If a complainant provides his/her name, that information is included in the public record. If a complaint is filed anonymously without contact information, please note we may not be able to follow-up on the complaint if more information is needed (such as exact location of complaint cannot be identified).
If the property is in the City of Columbus do not submit your request here. Please submit it to Columbus at 311.columbus.gov/. Not sure? Check the address at: gis.columbus.gov/zoning/
Location Name
Business Name, Apartment Complex, etc. (if applicable).
Complaint Location*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
City, Township or Village Name
Complaint Type (select all that apply)*
Please provide a detailed description of the complaint*
Picture

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Additional Complaint Documentation

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Please provide the best day(s) and time(s) you're available for us to contact you.

	Monday	Tuesday	Wednesday	Thursday	Friday
Morning (8 a.m. - 11 a.m.)
Midday (11 a.m. - 3 p.m.)
Afternoon (3 p.m. - 5 p.m.)

Your Contact Information

Name

Street Address

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
E-mail
Enter the message as it's shown*
Should be Empty:

Public Health Nuisance Referral Form