Food complaint form

Please note: Section 610 of Missouri State Law (Missouri Sunshine Law) requires that records of government agencies be open to the public. Therefore, this complaint form is accessible to anyone who requests a copy in writing. A summary of the Missouri Sunshine Law is available for review online at http://ago.mo.gov/sunshinelaw/sunshinelaw.htm

Person filing the complaint

Name

First Name

Last Name

Phone

(###)

###

####

Email

Location of complaint

Name of food establishment

Address of food establishment

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please provide a description of the complaint

AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER – SERVICES PROVIDED ON A NONDISCRIMINATORY BASIS

Lincoln County Health Department works cooperatively with Lincoln County and surrounding areas to protect and promote a healthy and safe environment through community outreach, health care, and education.