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2. If you notice a regular pattern of smoking or vaping (someone continuing to smoke in a smoke-free area), please use the anonymous reporting tool.
4. What day did the violation take place?
   -- Select One --MondayTuesdayWednesdayThursdayFriday
5. What time did the violation take place?
   -- Select One --Before 8 a.m.8 to 10 a.m.10 a.m. to NoonNoon to 2 p.m.2 to 4 p.m.4 to 6 p.m.Weekends or Outside of Business Hours
7. Location of Violation
9. Product

   1. Cigarette
   2. Vapen Pen/E-Cigarette
   3. Marijuana
   4. Unsure
10. Occupation of Non-Complaint Individual (If Known)

    1. Client/Visitor
    2. Placer County Employee/Staff
    3. Contractor
    4. Unsure
12. Did you inform the non-compliant individual about the smoke-free campus ordinance, and where the designated smoking areas are located?

    1. Yes
    2. No
14. Comments
16. Anonymous reports are welcome. Do you wish to be contacted about your report? If so, please include your name and contact information below (not required).
18. Name
20. Phone Number
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field