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Face Mask Complaint Form

  1. Face Mask Complaint Form

  2. Please complete the following sections of this online, fillable form to file a complaint regarding non-compliance with Wisconsin Emergency Order #1 Regarding Face Mask Use in Public, Indoor or Enclosed Environments. Please Note: All fields with an asterisk (*) are required.

  3. Your completed form will be submitted by email to At that time, you may choose to have a copy emailed to you for confirmation and for your recordkeeping. All complaints will be initially fielded by Public Health, and if second offenses, will be forwarded to the District Attorney's Office.

  4. For more information on Wisconsin Emergency Order #1, go to:

  5. Name of Person Filing a Complaint

  6. Reporter's name and phone number would be used if more information is needed.

  7. Complaint Details

  8. Description of the face mask violation/offense.

  9. Witness Detail (if Applicable)

  10. Name, city, and phone number would be useful if available.

  11. Evidence

  12. What supporting evidence are you providing?

  13. Please provide a current photo of the person violating the face mask order, if available.

  14. Optional.

  15. Any additional evidence.

  16. Optional.

  17. Any additional evidence.

  18. Complaint Outcome

  19. For example: Education by telephone, educational materials by mail, letter from public health, fine, etc.

  20. By submitting this online complaint form, I state that the information I have provided is true and accurate to the best of my knowledge. This complaint and the information provided will be used in efforts to resolve the problem and will typically be shared with the party complained against. It may also be used to enforce applicable state laws and orders. Under Wisconsin's Open Records Law, Wis. Stats. SS 19.31, this complaint will be available for public review upon request. The department will maintain the confidentiality of your personally identifiable information to the fullest extent permitted by law.

  21. You may choose to have a copy of this completed complaint form emailed to you for confirmation and for your recordkeeping.

  22. Leave This Blank:

  23. This field is not part of the form submission.