This form is to be used for filing a complaint regarding a
potential violation of the Pennsylvania Clean Indoor Air Act, referred to as the CIAA.
The CIAA prohibits an individual from engaging in smoking in a public place, and requires
business owners to prohibit smoking and post signs where required.
This form is to be used to report the following potential violations:
- The owner, operator or manager of the premises may be penalized for failing to post proper signage
- The owner, operator or manager of the premises may be penalized for allowing smoking where it is prohibited
This form can be completed electronically by tabbing from field to field and entering the
required information. Describe what you observed in as much detail as you can. If the
possible violation(s) you describe are not all in one area, identify the location of each
possible violation individually on separate forms. Once you have completed the form you
can click the ‘Submit’ button.
If you are uncertain about how or where to submit the Form, or would like more
information, call the Pennsylvania Department of Health (DOH) at (717) 783-6600. Click here
to learn more.
The DOH will review violation reports and
submit to the appropriate law enforcement agency. The information provided including your contact information will be kept confidential.