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2. Complete the following form and select the submit button to notify the Inspection Services Division of a code violation, or building or fire safety issue. The form can only be used for reporting code violations or safety issues that occur within the city limits of the City of Rockville. Providing personal information is not necessary.
4. Complaint*
6. Date Witnessed
   Date Witnessed
8. Company (if applicable)
10. Address of Complaint*
14. Contact Information (Optional)
16. First Name
17. Last Name
19. Email
21. Phone
25. I would like to be contacted about this complaint (please provide e-mail address or phone number)

    1. Email
    2. Phone
27. Phone Number
29. Email
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit Submit and Print

* indicates a required field