GENERAL COMPLAINT FORM
Date:________________
Reported by: ________________________________________________________
Address: ________________________________________________________
Phone : __________________________

I have a concern about the following: PROPERTY/ ROAD/ ANIMAL /OTHER Location:_____________________________________________________________________________________________________________________________________ CONCERNS:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Signature:________________________
Received by:______________________  	Referred to:_______________

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OFFICE USE ONLY: Complaint #: ________________
Inspection Date: __________________________

GENERAL COMPLAINT FORM cont’d    Complaint #:______________

Conditions Found:
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Actions taken:__________________________________
Letters of Violation Sent: ________________________________________
Compliance Achieved Date: ______________________________________
Comments: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Personal information contained on this form is collected pursuant to Freedom of Information and Protection of Privacy legislation and will be used for the purpose of complaint investigation and resolution.  Questions about this collection should be directed to the JOHNSON Township Office located at 1 Johnson Drive, Desbarats, ON P0R 1E0 Phone:  705-782-6601