*required

*Name of Business

*Street Address

Cross Street

Zip Code

Phone Number

-Select Business Type- Restaurant Bar Bowling Center Bingo Hall Pool Hall Theater School Office Grocery Store Auto Repair Parking Garage Apartment Building Liqour Store Convenience Store Public Park Other

If other, describe below:

*Date of occurrence 

*Time of occurrence

am  pm

Select location within establishment

-Select location within business- Dining Room Stairwell Outdoor Dining Area Covered Outdoor Area Lobby Lounge Bathroom Kitchen Office Bar Other  

If other, describe below:

Customer smoking

Smoking in park owned by the City of Pasadena

Ashtray present in no-smoking area

Smoking allowed in no smoking area

Employee/Owner smoking

No-smoking sign not posted

Smoking policy not posted/disseminated

Other (describe below)

Briefly describe the violation below:

I would like to remain anonymous

Your name

Phone number

E-mail address

Your street address

City

State

Zip code

The City of Pasadena Public Health Department, Tobacco Control Program will respond to complaints about violations of the state and local tobacco control laws within 24 hours of receipt during regular business hours, including outdoor air violations, such as 100% smoke-free park  smoking violations in smoke-free areas. The Pasadena Tobacco Control Program (TCP) will take whatever action may be indicated by the circumstances, including inspections, as necessary, to determine if there are in fact violations of the smoking regulations. Please be aware that tobacco shops and cigar lounges are exempt from local and state tobacco control laws.