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2. Cowlitz County Health & Human Services has jurisdiction for food safety complaints related to restaurants, espresso stands, mobile food units, and grocery stores. For other complaints like meat processors and home-kitchens, please see the list of contacts here. 

4. Restaurant or other establishment name or description.
6. Establishment location/address
8. Enter detailed information about any complaints, comments or questions you may have or why you would like to schedule an appointment.
10. Please provide contact information so that we may contact you in case we have questions about the complaint or issue you need to address. If you wish to remain anonymous please indicate below. Please note that if a public records request is submitted we may be required to provide the completed form to the requester.
12. First Name
13. Last Name
15. Address1
17. Address2
19. City
20. State
21. Zip
23. Phone Number
24. Alt Phone Number
26. Email Address
28. Date and time of the incident
    Date and time of the incident

    Date and time of the incident
30. Do you wish to remain Anonymous?

    1. No
    2. Yes
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field