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2. The health department enforces the Smoke-Free Illinois Act and follows up with any complaints received. Please complete the following fields to submit a complaint regarding a potential violation of the Smoke-Free Illinois Act observed in McLean County. Information entered in this form, including your name, will be provided only to the health department so we have the necessary information to follow-up on complaints. If you have trouble filling out this form, please call (309) 888-5968.

4. Smoke-Free Illinois Act Information
   Click here to learn more about the Smoke-Free Illinois Act
6. Complaint Information
8. Date of Incident:*
   Date of Incident:
9. Time Incident Occurred:*
   Time Incident Occurred:
11. Business Name (or place of violation):*
12. Business Owner (if known):
14. Business Address:*
16. City:*
17. State:*
18. Zip:*
20. Type of Violation:*

    Check all that apply

    1. Smoking indoors or in a public place or workplace where prohibited
    2. Smoking within 15 feet from etrances/exits/windows that open or ventilation intakes
    3. Smoking in a vehicle owned/leased/operated by the State or a political subdivision of the State
    4. Owner/operator/manger did not post "No Smoking" sign(s)
    5. "No Smoking" signs not posted at entrances
    6. Ashtray and/or smoking receptacle where prohibited
    7. Other
22. Person observed smoking:

    1. Employee
    2. Customer
    3. Business owner
24. Additional detailed information about the violation:*

    (Up to 2000 characters)

26. Is this your first complaint about this business?*
    -- Select One --YesNo
28. If no, how many have you submitted to this business?
30. Was incident reported to staff?*
    -- Select One --YesNoNot sure
34. Citizen Contact Information
36. Your name:*
37. Phone number:*
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit Submit and Print

* indicates a required field