Section 1. Information of person reporting complaint
When submitting this complaint, you may identify yourself in doing so. If you choose to submit this complaint anonymously, it is very important that you provide accurate and complete information on how the Connecticut Department of Public Health can contact the alleged violator and any witnesses.
Section 2. Alleged Violator Information
Section 3. Description of violation
Is there anyone else who can verify this information? If yes, please provide the following: