General Complaint Form

ST. CLAIR COUNTY COVID-19 COMPLAINT FORM

Completion of this form certifies that you have witnessed an establishment within St. Clair County, MI that is not complying with the latest Emergency Epidemic Orders issued by the Michigan Department of Health & Human Services.
Anything with a * is required to process this request. All personal information will be kept confidential to the extent as permitted by law.
DATE OF EVENT/VISIT:

Month Day Year
Date
FACILITY NAME: *
ADDRESS:
FACILITY TYPE: *
PHONE:
OWNER/ MANAGER (if known):
DESCRIPTION OF COMPLAINT: *
YOUR NAME: *
YOUR PHONE NUMBER: *
YOUR EMAIL:
example@example.com
DATE:

Month Day Year
Date
IF POSSIBLE, PLEASE UPLOAD A PICTURE IN SUPPORT OF YOUR COMPLAINT.

Cancel of
Should be Empty: