Smoke Free Arizona

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Updated on 3/26/2009

Before using this form, please check the exemptions page for information regarding some specific places where smoking is allowed.

County health departments will investigate complaints about alleged violations of the Smoke-Free Arizona Act. County health departments will notify the proprietor of the public place or place of employment and/or conduct an inspection within 15 days after receipt of a complaint.

When filling out this form, required fields are indicated by a red asterisk ( *).

If you are having trouble filling out this form, please call 1-877-297-8677.

Citizen Complaint Information

You may submit your complaint anonymously. If you wish to remain anonymous, please skip to Step 2. All 4 fields here in Step 1 are optional.

First Name

Last Name

Phone
(include your area code)
Providing your phone number is not required, but will help the county health department if they need further information.

Email

By providing your email address, you will receive an email with your complaint ID number and the county contact information for you to follow-up should you have any questions.

Complaint Information

Sufficient information, including the name and exact physical address, must be provided in this step in order for your complaint to be addressed.

*Name of Business/Workplace Not in Compliance

*Address or Physical Location of Complaint(s)

Major Cross-Streets

*City

Zip Code

*Date and Time of Violation

Day

Time :

To continue to Step 3, either scroll up or click here.