Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Jefferson County Public Health Concern/Complaint Action Request for Environmental Health

  1. In an effort to streamline office processes and response times, we prefer that all complaints be submitted electronically for proper processing. If you would not like to submit electronically and/or do not have access to a computer, we would be happy to take your complaint over the phone.

  2. Your Contact Information

    Fill in the information below. Include at least one way to contact you if the need arises--either your email address, mailing address or phone number. We do not accept anonymous complaints. 

  3. This complaint form is a public record and is subject to disclosure under the Public Records Act (42.56 RCW). Please let us know if you would like information revealing your identity to remain confidential and exempt from public disclosure. PLEASE NOTE: Due to state law, complaints that engage the judicial system for resolution may not be able to remain confidential. Note also that while confidentiality is allowed, anonymous complaints are not accepted. Please indicate your desire below:

  4. Please choose one answer*
  5. Life/Safety Concerns?

    I am concerned about my life and/or safety if this complaint does not remain confidential in accordance with RCW 42.56.240(2): "Information revealing the identity of persons … who file complaints with investigative, law enforcement, or penology agencies … if disclosure would endanger any person's life, physical safety, or property. If at the time a complaint is filed the complainant … indicates a desire for disclosure or nondisclosure, such desire shall govern.”

  6. Concern/Complaint Regarding

    Fill out this form as completely as possible regarding the location you are concerned about. Address or parcel information is mandatory.

  7. If no address, please describe location. 

  8. We need to know the parcel # so we can easily find the location of concern. You can look up the parcel # by looking it up in our Parcel Search Tool:

  9. Department/Program Area

    IF THIS IS A BUILDING COMPLAINT please file your complaint with the Jefferson County Department of Community Development at this link:

  10. Note: Any site visitation due to this complaint will be in compliance with Jefferson County policies and procedures regarding trespassing. 

  11. Click "browse" to upload any supporting documentation. 

  12. Leave This Blank:

  13. This field is not part of the form submission.