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2. Report a Public Health Problem

   This is the form you need to use to report a public health problem such as health violations related to a licensed childcare, pool/spa, or tattooing facility, sewage or chemical spills, waste issues, indoor/outdoor air quality problems, water problems, or animals bites. The location of the problem must be within Jefferson County, Colorado.

4. IMPORTANT NOTE
   Jefferson County Public Health does not have enforcement authority for all public-health related complaints, such as housing, mold, bed bugs, trash and work safety. If you have a problem related to trash, contact your local code enforcement. If you have a problem related to housing, contact Colorado Housing Connects (https://coloradohousingconnects.org/). If you have a question about a topic not listed below, please call our main office at 303-232-6301.
6. First Name*
7. Last Name*
9. Address*
11. Address Line 2
13. City
14. State
15. Zip Code
16. Country
18. Email Address*
19. Daytime Phone Number*
21. Please indicate the area of your problem by checking the appropriate box(es):

    1. Air Quality - Outdoor
    2. Animal Bite
    3. Child Care

    1. Mosquitoes
    2. Pool or Spa
    3. Tattooing

    1. Wastewater or Septic
    2. Water Quality
    3. Other
23. Name of property or business where the problem is occurring*
25. Location of the Problem*
27. Address Line 2
29. City
30. State
31. Zip Code
32. Country
34. Describe the problem or concern in specific detail*
36. Attach related photos or documents if applicable
38. Information submitted on this form will be sent via unsecured email. To protect sensitive information, do not enter the following items or similar information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, credit card numbers, medical information, passport numbers, and passwords. Please review our privacy policy located at www.jeffco.us/privacy. By submitting this form, you acknowledge and accept the terms listed in the privacy policy.
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40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field