Complaint Form

Complaint Form
NC State Board of Environmental Health Specialist Examiners

To find out more about the NC State Board of Environmental Health Specialist Examiners Complaint Process, visit the Board’s Complaint Process. After reviewing the aforementioned page, if you decide to file a complaint against a Registered Environmental Health Specialist or Environmental Health Specialist Intern (hereinafter referred to as REHS), you may do so either directly online (see below) or manually using this form.

In order for the Board to have information necessary to begin investigation of your complaint, it is important that you provide all requested information in as much detail as possible. A copy of the complaint will be given to the REHS named. At the completion of the investigation and final decision by the Board, the complaint will become a public record. Individuals who file complaints must be willing to appear as a sworn witness to testify and be cross-examined concerning the allegations made in their complaints, if necessary.

If filing a manually completed complaint packet via the postal service, mail your completed complaint packet to: NC State Board of Environmental Health Specialist Examiners Board, PO Box 238, Efland, NC 27243.

Should you have questions, contact the Board office by email (rehs.board@dhhs.nc.gov) or telephone ( 919.304.1168 ).

* Denotes Required Field

Section 1. Complainant (Person Filing Complaint)
Full Name*
First Last
Mailing Address (All fields are required)*
Street or Post Office Box Address Address Line 2 City State ZIP Code
Telephone/ Cell Phone*
Email
Complainant Business/Employer Information (Complete only if relevant to the Complaint.)
Business/Employer Name
Business/Employer Address Business/Employer Address 2 Business/Employer City Business/Employer State Business/Employer Zip Code
Business/Employer Telephone
Business/Employer Email
Section 2. REHS Information.
REHS #1
REHS #1 Name*
First Last
REHS #1 Number
Please enter a number from 0 to 5000.
REHS #1 Employer Name*
For choices outside of local/district Health Departments, please scroll to the bottom of this pick list.
REHS #1 Employer Address
REHS #1 Employer Address Address Line 2 REHS #1 City REHS #1 State REHS #1 Zip
REHS #1 Telephone
REHS #1 Email
REHS #2 (If Applicable)
REHS #2 Name
First Last
REHS #2 Number
Please enter a number from 0 to 5000.
REHS #2 Employer Name
For choices outside of local/district Health Departments, please scroll to the bottom of this pick list.
REHS #2 Address
REHS #2 Address Address Line 2 REHS #2 City REHS #2 State REHS #2 Zip
REHS #2 Phone
REHS #2 Email
Section 3. Complaint Details.
Have you consulted an Attorney regarding your complaint?*
- Yes.
- No.
Attorney Name*
First Last
Attorney Address*
Street Address Address Line 2 City State ZIP Code
Attorney Phone*
Attorney Email*
Is there a pending or completed lawsuit regarding your complaint?*
- Yes
- No
Detailed Description*
In the space below, provide a detailed statement describing your complaint. If you need additional space and are completing this form online, upload additional documents as needed. It is important to include the name, address, and telephone number of witness(es) if applicable.
Additional File (accepted types: doc, docx, pdf)
Accepted file types: doc, docx, pdf, Max. file size: 10 MB.
In order for the Board to investigate your complaint thoroughly and in a timely manner, it is important that you furnish copies of all documents relevant to your complaint (contracts, letters, leases, etc.), retaining the originals for your files.
By clicking "I agree", I hereby affirm that the foregoing statement and the attachments hereto are true and agree with the Complaint Process outlined in the prelude to this online Complaint form. Additionally, you acknowledge this step constitutes as your official online signature.*
Terms of Usage*
I agree
Name
This field is for validation purposes and should be left unchanged.

Complaint Form NC State Board of Environmental Health Specialist Examiners

Complaint Form
NC State Board of Environmental Health Specialist Examiners