Submit a Complaint Anonymously

Before using this form, please check the Exemption Fact Sheet   regarding some specific places where smoking is allowed. Local law enforcement may investigate complaints about alleged violations of the Smokefree Air Act. The Iowa Department of Public Health, Division of Tobacco Use Prevention & Control may notify the proprietor of the public place or place of employment or coordinate a site visit after receipt of a complaint.

When filling out this form, required fields are indicated by a red asterisk (*). By submitting anonymous complaints, IDPH is impaired in its ability to immediately address the alleged violations because further investigation is required. As such, IDPH strongly suggests that you leave your name and contact information to better expedite this process.

If you are having trouble filling out this form, please call 1-888-944-2247. You may also manually submit a complaint via mail by clicking here    to download a form.

NOTE: Complaints should be filed within 10 days of observing potential violation(s), in order to facilitate a timely investigation.

Step 1

Complaint Information

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

*Name of Business/Workplace

*Business/Workplace Type
Automobile Dealer Bar Bingo Parlor Bowling Alley Business Office Childcare Provider Concert Hall Convenience Store Educational Facility Factory Financial Institution Gallery Gambling Facility Golf Course Government Healthcare Provider Hotel/Motel Indoor Arena Laundromat Library Liquor Store Outdoor Entertainment Event Pharmacy/Drug Store Private Club Public Transportation Restaurant Retail Store Shopping Mall Stadium Theater Tobacco Store Zoo/Aquarium Other
*Address 1

Address 2

*City 

Zip Code
+4
Major Cross Streets

*Date and Time of Violation
Date:

Time: 1 2 3 4 5 6 7 8 9 10 11 12 : 00 15 30 45   AM PM

Step 2

Complaint Description

*Complaint Description (check all that apply)

Smoking in Prohibited Areas
Evidence of Smoking in Prohibited Areas (i.e. ashes, tobacco products, etc.)
Ashtray(s) Present
Signs Not Posted
Improper Signage
Smoke Infiltrating Areas Where Prohibited (only applicable in Private Clubs, Long Term Care Facilities, Tobacco Retail Stores, & Hotels/Motels)
Other       

*Complaint Location(check all that apply)

Enclosed Areas:

Bar Area
Dining Area
Break Room/Cafeteria
Restroom
Hallway
Stairway/Stairwell
Vehicle
Garage
Loading Dock
Elevator
Kitchen
Retail Area
General Work Area
Not Applicable
Other       

Outdoor Areas:

Entertainment Venue
Restaurant Seating/Serving Area
Area Declared Non-smoking
Grounds of Public Building
Not Applicable
Other       

Please provide some additional details in regards to what you saw. This field is required.

* Additional Information
 

* Consent to submit an Anonymous Complaint
 

Please check one: