Commercial complaint health and safety form

This form is for making complaints about activities that may affect health and safety at certain types of commercial premises in Islington, eg shops, restaurants, pubs, clubs, theatres, gyms and special treatment premises.

For other types of commercial premises, eg manufacturing premises, NHS premises, HMP premises, building sites, education premises and council premises all complaints must be made to HSE.

Complainant details

First name

Last name

Address

Postcode

Phone number

Details of incident

Please describe the incident or activity

Date the incident or activity took place

Time of incident or activity (approx)

Name/Business name

Business address

Business postcode

Why were you at the business where the incident or activity took place?

I am employed at the business
I was delivering to the business
I was a customer at the business
I was a client or guest at the business
I own the business as a sole trader
I am a director of the business
Other

If other, please provide details below

Privacy statement

The information you provide will be used solely for the purpose of investigating your complaint and may be shared within the council but your details will not be shared with the business. Complaint information is retained for seven years from closure of the case.

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Commercial complaint health and safety form

Complainant details

Details of incident

Privacy statement