Premises Hygiene Complaint Form

Section 1: about you (please note: we are unable to investigate anonymous complaints)

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Email *

Section 2: about the premises

Business name

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date and time you visited

Date

Time

Section 3: your complaint

Please detail the problems you witnessed

What was the business’s response to your concerns?

Were you offered a refund or other compensation?

Date

Comment