Complaint Form - My Safe Florida Home

My Safe Florida Home
Contractor / Inspector Complaint Form
(Formulario de
Reclamaciones)

Case ID* (Número de Caso)

First Name* (Nombre)

Last Name* (Apellido)

Email* (Correo Electrónico)

Phone Number* (Número de Telefono)

Complaint Reason* (Motivo de la reclamacion)

Contractor Name

Inspector Name

Please provide more details about your complaint*
Por favor incluya mas detalles sobre su reclamacion

Please provide additional documentation to support your complaint (PDF document - 8MB Limit)
(Proporcione documentación adicional para respaldar su reclamacion)

I have carefully read and fully understand that any false statement made on this My Safe FL Home Complaint Form with the intent to mislead a public servant in the performance of his or her official duty can be found guilty of a Misdemeanor in the Second Degree pursuant to section 837.06, 775.082, and 775.083, Florida Statutes.

My Safe Florida Home Contractor / Inspector Complaint Form (Formulario de Reclamaciones)

My Safe Florida Home
Contractor / Inspector Complaint Form
(Formulario de
Reclamaciones)