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2. You may file a complaint if you have observed a violation of the Smoke-Free Public Places Rule in Orange County, North Carolina. The information you provide will be received by Orange County Health Department who will respond to the reported violation.

   Complaints are a matter of public record and confidentiality cannot be guaranteed. You may submit your complaint anonymously, but the health department will not be able to contact you if more information is needed.

   You can contact the smoke free Orange County Help Line by calling 919-245-2480.

4. Date & Time of Violation*
   Date & Time of Violation

   Date & Time of Violation
6. Location of Violation*
   Include Name of Business or Address if Applicable
8. Type of Violation

   1. Smoking inside a business or public building
   2. Smoking in a County or Town-owned vehicle
   3. Smoking on County or Town property
   4. Ashtrays or other smoking receptacle(s) are present
   5. A person in charge of a public area had knowledge that someone was smoking in a prohibited area and did not direct the person to extinguish the lit tobacco product or to leave the premises
   6. Other
9. Type of Town Property

   1. Park, playground, or athletic field
   2. Bus stop
   3. Outside of building
   4. Public transportation
   5. Sidewalk
11. Who did you observe smoking?

    1. Customers
    2. Employees
    3. Unknown / Not Sure
    4. Not Applicable
13. Briefly Describe the Violation
15. Your Contact Information
17. Your Name
19. Your Email
20. Your Phone Number
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field