COVID-19 Complaint Form to Report Business Engaging in Risky Practices for Public Health

2. Thank you for taking the time to report a business you found engaging in risky behavior with respect to spreading COVID-19. Please take a couple of minutes to answer the questions below which enable us to address this concern.

   Thank you for taking the time to report a business you found engaging in risky behavior with respect to spreading COVID-19. Please take a couple of minutes to answer the questions below which enable us to address this concern.

4. This form is for complaints about businesses only. For complaints involving parks, other public spaces, or other non-business complaints, please contact law enforcement at 360-344-9779, ext. 0.

   This form is for complaints about businesses only. For complaints involving parks, other public spaces, or other non-business complaints, please contact law enforcement at 360-344-9779, ext. 0.

6. Type of Business*
   -- Select One --RestaurantBar, no foodRetailOther

8. Name of Business or Organization*

10. Address

12. City

13. State

14. Zip Code

16. Nearest town:*
    -- Select One --Port TownsendPort LudlowPort Hadlock-IrondaleMarrowstoneChimacumQuilceneBrinnonDiscovery BayGardnerQueets

18. COVID-19 Health Concern (Check all that apply):*

    1. Non-essential business is opened before allowed by my county’s reopening phase
    2. Business is not requiring employees or customers to wear face coverings
    3. Staff not wearing mask
    4. Staff wearing mask improperly
    5. Other customer not wearing mask or wearing it improperly
    6. Business is not requiring 6 feet of physical distancing
    7. Too many people allowed to gather
    8. Staff not washing hands or using sanitizer after touching currency or items handled by customer(s)
    9. Staff not sanitizing tables, chairs, door handles, equipment (such as credit card machines), etc. touched by customer(s)
    10. No washing station or sanitizer available for employees
    11. Other Concern

20. If Other Concern

22. Date/Time concern witnessed:
    Date/Time concern witnessed:

    Date/Time concern witnessed:

24. If you would like us to contact you for further information please provide the following:
    Important Notice: The following information is not required. If you provide it or if you request an email containing this information, it will become a public record subject to public disclosure pursuant to the Washington State Public Records Act.

    Important Notice: The following information is not required. If you provide it or if you request an email containing this information, it will become a public record subject to public disclosure pursuant to the Washington State Public Records Act.

26. First Name

27. Last Name

29. Phone Number

30. Check if this is a cell and receives text messages

    1. Send me a text message

32. Email Address

Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field