2. In an effort to streamline office processes and response times, we prefer that all complaints be submitted electronically for proper processing. If you would not like to submit electronically and/or do not have access to a computer, we would be happy to take your complaint over the phone.

4. Your Contact Information

   Fill in the information below. Include at least one way to contact you if the need arises--either your email address, mailing address or phone number. We do not accept anonymous complaints. 

6. Your First Name*
7. Your Last Name*
9. Address
11. City
12. State
13. Zip Code
15. Phone Number*
16. Email Address

18. This complaint form is a public record and is subject to disclosure under the Public Records Act (42.56 RCW). Please let us know if you would like information revealing your identity to remain confidential and exempt from public disclosure. PLEASE NOTE: Due to state law, complaints that engage the judicial system for resolution may not be able to remain confidential. Note also that while confidentiality is allowed, anonymous complaints are not accepted. Please indicate your desire below:

20. Please choose one answer*

    1. Do not allow public disclosure of information revealing my identity

    1. Allow public disclosure of information revealing my identity
22. Life/Safety Concerns?

    I am concerned about my life and/or safety if this complaint does not remain confidential in accordance with RCW 42.56.240(2): "Information revealing the identity of persons … who file complaints with investigative, law enforcement, or penology agencies … if disclosure would endanger any person's life, physical safety, or property. If at the time a complaint is filed the complainant … indicates a desire for disclosure or nondisclosure, such desire shall govern.”

    1. Yes
    2. No
24. Concern/Complaint Regarding

    Fill out this form as completely as possible regarding the location you are concerned about. Address or parcel information is mandatory.

26. Name
27. Email Address
29. Address you have a concern about.

    If no address, please describe location. 

31. City
32. State
33. Zip Code
35. Phone Number*
36. 9-digit Parcel Number (if applicable)*

    We need to know the parcel # so we can easily find the location of concern. You can look up the parcel # by looking it up in our Parcel Search Tool: https://gisweb.jeffcowa.us/LandRecords/

38. Department/Program Area

    IF THIS IS A BUILDING COMPLAINT please file your complaint with the Jefferson County Department of Community Development at this link: https://www.co.jefferson.wa.us/formcenter/dcd-11/complaint-form-70

    1. Onsite Septic
    2. Solid Waste
    3. Food
    4. Water Quality
    5. Drinking Water/Wells
    6. Tobacco
40. Other
42. Specific location of problem on property listed above (or adjacent address)
44. Are there any gates, dogs, no trespassing signs, mile markers, etc.?

    Note: Any site visitation due to this complaint will be in compliance with Jefferson County policies and procedures regarding trespassing. 

46. Description of Complaint
48. File upload

    Click "browse" to upload any supporting documentation. 

Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field