Report an Environmental Health Problem JavaScript Required You must have JavaScript enabled to use this form. Please enable JavaScript and reload the page. If you cannot enable JavaScript, please contact webadmin@cityofmadison.com to provide your information. Type of Report - Select -Public Swimming Pool / WhirlpoolRestaurant or Retail Food EstablishmentSeptic System IssueLodging ConditionsMoldAir Quality ProblemPestsUnsanitary Living ConditionsTattoo or Body Piercing Establishment Date of Incident Address of Incident Street Address Unit City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Code Please describe the incident, including date, time and location. Photo Upload One file only. 10 MB limit. Allowed types: . Upload Have you reported this incident before? Yes No Contact Information Name Would you like us to contact you? No, do not contact me. Yes, by phone. Yes, by email. Email Phone Leave this field blank JavaScript Required You must have JavaScript enabled to use this form. Please enable JavaScript and reload the page. If you cannot enable JavaScript, please contact webadmin@cityofmadison.com to provide your information. Was this page helpful to you? Yes No Why or why not? Leave this field blank Report Report an Environmental Health Problem
