Get NV Complaint Form - Clark County

CLARK COUNTY FIRE HAZARD PREVENTION SERVICES DIVISION 575 E. Flamingo Rd Las Vegas NV 89119 Phone 702 455 3396 Fax 702 455 7347 Please fill out the form to the best of your knowledge and be as specific as possible. Required fields are denoted with an asterisk. Note Sufficient information must be provided in order for your complaint to be addressed. Today s Date Please provide information about the non complying party in this section. Street Address City State Zip code Cross Streets / For example Sahara/ Las Vegas Blvd. Corner of Intersection NE NW SW SE Residential Commercial Business Name Date of Incident/Report Please indicate if this issue in your opinion represents an imminent risk to life or limb Nature of Issue Alarms Locked/ Disabled/ Obstructed Exit Barbeque Issues Monitoring False/ Nuisance Alarms Open burning Fire Extinguishers Overcrowding Fire Hydrants/ Fire Lanes Other Kitchen Extinguishing Systems Public/ Private Water Supply Yes No School drills Spray Painting Sprinklers Work done without Permit Complaint Description Are you a Clark County Fire Department Employee If you are a Clark County Fire Department employee enter Station Number and Platoon Station Platoon Complainant s Contact Information Note Providing your contact information is not required however it will help us in contacting you if we need further information. Name first middle initial and last Phone Number Email Address Mailing Address I would like to be notified of the inspection results. CLARK COUNTY FIRE HAZARD PREVENTION SERVICES DIVISION 575 E* Flamingo Rd Las Vegas NV 89119 Phone 702 455 3396 Fax 702 455 7347 Please fill out the form to the best of your knowledge and be as specific as possible. Required fields are denoted with an asterisk. Note Sufficient information must be provided in order for your complaint to be addressed* Today s Date Please provide information about the non complying party in this section* Street Address City State Zip code Cross Streets / For example Sahara/ Las Vegas Blvd. Corner of Intersection NE NW SW SE Residential Commercial Business Name Date of Incident/Report Please indicate if this issue in your opinion represents an imminent risk to life or limb Nature of Issue Alarms Locked/ Disabled/ Obstructed Exit Barbeque Issues Monitoring False/ Nuisance Alarms Open burning Fire Extinguishers Overcrowding Fire Hydrants/ Fire Lanes Other Kitchen Extinguishing Systems Public/ Private Water Supply Yes No School drills Spray Painting Sprinklers Work done without Permit Complaint Description Are you a Clark County Fire Department Employee If you are a Clark County Fire Department employee enter Station Number and Platoon Station Platoon Complainant s Contact Information Note Providing your contact information is not required however it will help us in contacting you if we need further information* Name first middle initial and last Phone Number Email Address Mailing Address I would like to be notified of the inspection results. .