Human Health Hazard Reporting Form

Address of hazard(s)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Is this a rental property?*

YesNoUnknown

Has the landlord been notified of the hazard(s)?*

YesNoUnknown

Date the landlord was notified of the hazard:

Please allow at least 2 weeks after notifying the landlord of the hazard before contacting the Monroe County Health Department in order to allow the opportunity for proper mitigation to take place.

Please notify the landlord of any hazards prior to contacting the Monroe County Health Department so that they may have a chance to address the issue.

Name of landlord*

First NameLast Name

Phone number of landlord*

Please enter a valid phone number.

Email of landlord*

example@example.com

Type of hazard (Select all that apply)*

Other: Please describe here.

Description of hazard(s).*

File Upload: Please share any photos or additional files here

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Your name*

First NameLast Name

What is the best way to reach you with questions?*

PhoneEmail

Phone Number

Area CodePhone Number

E-mail

example@example.com

Disclaimer

Submitting this form is only a method for informing the Monroe County Health Department of a potential hazard. All submitted requests will be viewed as information only and will be directed to the proper channels for investigation and follow up. Submission of this form does not acknowledge confirmation of reported hazard. If it is determined that the alleged issue could be a human health hazard, a hazard case is opened to investigate the matter.

Chapter 15 - HEALTH AND SOCIAL SERVICES | Code of Ordinances | Monroe County, WI | Municode Library