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COVID-19 Violation Form

2. This form is for residents wishing to file a complaint with the city of St. Joseph Health Department concerning a violation of the current Declaration of Emergency. For any additional questions or concerns, please call the health department at 271-4636.

   This form is for residents wishing to file a complaint with the city of St. Joseph Health Department concerning a violation of the current Declaration of Emergency. For any additional questions or concerns, please call the health department at 271-4636.

4. Date and Time*
   Date and Time

   Date and Time

6. Name *

8. Call Back Number*

10. Where the Violation Occurred*

12. Date and Time of Violation*
    Date and Time of Violation

    Date and Time of Violation

14. Please Explain the Violation*

Leave This Blank:


16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

18. Submit

* indicates a required field