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Report Secondhand Smoke & Vapour

Thank you for agreeing to participate. It will only take a few minutes to complete. All of your answers are private and confidential.

What Township or Municipality were you in? (Required)
What was the name of the place or address where you saw, or were exposed to second hand smoke or vapour? (I.e. restaurant patio, playground, sports field, arena, etc.)
What was the secondhand smoke or vapour you were exposed to?
Please check all that apply (Required)
When were you exposed to secondhand smoke or vapor? (Format: yyyy-mm-dd. The minimum date is '1919-08-24'. The maximum date is '2029-08-24'. Required)
Peterborough Public Health will investigate each complaint received. If you want Peterborough Public Health to follow up with you directly, please include your name, phone number and/or e-mail in the space below. All reports are voluntary, confidential and will be kept anonymous.