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Appeal an Inspection Finding

Appeals must be submitted within 5 business days of the issuance of the inspection report. Failure to submit a written request for appeal within 5 business days shall be considered grounds to deny an appeal. An appeal shall be heard by the Commissioner of Health or the Commissioner's authorized representative within 10 business days following receipt of a written appeal.

Attach a separate form for each violation that you are appealing, as well as any additional information and/or supporting evidence that you would like us to consider. If the form is not completed fully, the appeal process may be denied.

indicates a required field.


 
(Enter numbers only, or include parentheses, spaces, periods, or hyphens.)
(Enter date as MM/DD/YYYY)
(Enter the violation number exactly as shown on the inspection report.)
(Describe why you believe the cited violation is in error. You may also attach supporting documentation.)
Please upload any additional information you would like for us to consider 

The inspection report or inspection placard shall be updated based on the outcome of the appeal.

Signature Information
(Enter date as MM/DD/YYYY)