Submit a Complaint

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 will notify the proprietor of the public place or place of employment and/or coordinate a site visit 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 1-888-944-2247. 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

Citizen Complaint Information

The Division understands that you may want to remain anonymous. However, we may need to contact you to verify the information that you submit. Therefore, anonymous complaints will not be accepted.

*First Name

*Last Name

Address 1

Address 2

City

Zip Code
+4
Phone (including area code)

Email

Confirm Email

By providing your email address, you will receive an email confirming receipt of this complaint.

Step 2

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

*Address 1

Address 2

*City

Zip Code
+4
Major Cross Streets

*Date and Time of Violation
Date:

Time::

Step 3

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

Additional Information

* Consent

Please check one:

I understand information regarding the date, time, location, and circumstances of my complaint are public record. I also consent to the release of my name and contact information to the public.
I understand information regarding the date, time, location, and circumstances of my complaint are public record. I do not consent to the release of my name and contact information to the public at this time. I understand that my name and contact information will be released to the business owner in the event an enforcement action is pursued against this business.