Island Health Environmental Public Health Concerns Intake Form

Please complete this secure form to submit your concerns electronically.

The personal information requested on this form, and any additional information collected during the review of the complaint submitted by or on behalf of an individual, is collected under the authority of sections 26(c) and 26(e) of the Freedom of Information and Protection of Privacy Act (FIPPA). This information will be used only for the purpose of reviewing and addressing this complaint.

Please provide only the minimum personal information necessary to support your complaint and do not include personal information about other individuals unless it is essential for the review.

We will not share your personal information unless we are authorized to do so under FIPPA.

Please provide all relevant information requested in relation to your area of concern. Intakes that lack sufficient information may not receive follow‑up.

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.