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Smoke-Free Workplaces - Online Complaint Form

Please fill out this form to report violations of the Department of Health Functions Clarification 
Amendment Act of 2006, effective April 3, 2006.  The Department of Health will investigate 
the complaint with the information you provide.  
 
Please enter as much information as possible (items marked with a * are required 
before we can investigate).  Giving your name and contact information will enable 
us to contact you if we need additional information to respond to your complaint, 
but you may remain anonymous if you like.  
 
After you have entered the required information, use the send button 
at the bottom of the form to submit your form.  To make a change, use the Start Over 
button to erase all of the information entered.
 
If you have any questions or would like further information, 
please call the DC Tobacco Control Program at (202) 671−5000.
Location of Smoking Violation:
Washington DC
Time and Date of Violation:
Type of establishment:
Location within establishment where violation was observed:
Smoking Complaint Reported By (optional):
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