Report a Health & Safety issue

Please fill in details of the complaint or request below
Fields marked with * are required
Business Details
1. Business Name
2. Please enter your business address postcode and click on 'Find Address'. Then click on the drop down arrow on the address box and choose the correct address
3. Postcode:
5. Address:
6. Building Name
7. Address 1
8. Address 2
9. Address 3
10. Town
11. County
12. Postcode
Your Details
1. Please provide your details so we can contact you
2. Name*
3. Email Address*
4. Phone Number
5. Mobile Number
Are you completing this form on behalf of someone else?*
1. Yes
2. No
Assisted service details
1. In what capacity are you completing this form?:
  
  Carer
  
  Relative/Friend
  
  Parish Council/Clerk
  
  Norfolk Police
  
  Local Resident
  
  Social Services
  
  Contact Centre Staff
  
  Other
2. Name of person completing this online form:
3. Email of person completing this online form
Your Address
1. Please enter your address postcode and click on 'Find Address'. Then click on the drop down arrow on the address box and choose the correct address
2. Postcode:
4. Address:
5. Address 1
6. Address 2
7. Address 3
8. Town
9. County
10. Postcode