Jefferson County Health Department
715 Green Road
Madison, IN 47250
Phone: (812) 273-1942
Fax: (812) 273-1955
Environmental Health Complaint Form
Complaints registered with the Jefferson County Health Department must be in writing and signed by the person filing the complaint.
All complaints must be of Public Health or Environmental concern.
I, __________________________________________ hereby register a complaint with the Jefferson County Health Department regarding the following:
Name of Owner / Responsible party (if known): _________________________
Address / Location and Directions:
Reason / Concern for Complaint: