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  File a Complaint  
 
  After November 16, 2006, you may file a complaint regarding smoking violations by filling out the form below. You can also send a letter of complaint to the Hawaii State Department of Health, Tobacco Prevention & Education Program, 1250 Punchbowl Street #217, Honolulu, HI 98613-2416.

To file a complaint you will need the following information: The name and location (address if possible) of the business; date and time of the offense; and a brief description of what happened. Include whether you notified the owner/manager or employee of the business about the smoking violation and what action was taken. You will need to include your name, address and contact information.

Facility/Location Information
Name of Business/Workplace:
Address or physical location of complaint(s):
Type of Business
Restaurant Amusement: Billiard parlor, Bowling Alley
Bar/Nightclub Public Facility: Airport
Office Hotel
Retail Store Health Care Facility
Shopping Mall Other
Were signs prohibiting smoking posted?
Yes No Unknown/not sure
Date and time you saw someone smoking and/or saw an ashtray present in smoke-free area:
Saw someone smoking: Saw an ashtray present in smoke-free area:
Date (MM/DD/YYYY): Date:
Time: (00:00) Time:
If it was a person smoking, who was smoking: (Check all that apply)
Owner/Manager(s) Employee(s)/Workers Customer(s)/Visitor(s)
Unknown/not sure Other
Were signs prohibiting smoking posted:
Yes No Unknown/not sure
Description of smoking complaint:
Complainant Information
As an option, would you please provide your contact information:
Name:
Address:
Phone (888-8888):
Anonymous
 
**Names of complaints received will be kept confidential to the fullest extent of the law, however in certain situations in which penalties may be applied, your name may need to be divulged to attorney’s representing the parties in this matter.