Smoke Nuisance Investigation Request

Smoke Nuisance Investigation Request
For the City to investigate your smoke nuisance concerns, you must lodge this smoke investigation form and attach the following supporting documentation:
- Completed smoke investigation checklist, and
- Completed smoke nuisance log sheet.
It is important that you accurately record the smoke nuisance as it affects you, providing as much information as possible. This information should identify the source of the smoke (property address), the severity of the smoke and the dates and times of the nuisance.

This information will then be used to determine the nature of the nuisance and possibly identify a pattern of the smoke. Information provided will then assist the Environmental Health Officer to investigation your smoke nuisance concern.

Please Note:
- In some cases, legal action may be necessary to a resolve a smoke nuisance. In such cases, the evidence of persons affected by the smoke may be vital to achieving a successful outcome. Anyone making a smoke complaint should be aware that they may be required to give evidence in Court should the need arise.
- A mediation service is provided by the Citizens Advice Bureau and may be recommended by the City.
- The City is subject to the Freedom of Information Act 1992.
- The City will not commence investigation of your request until the Smoke Nuisance Investigation Request Form, the Assessment of Smoke Checklist and the accompanying Log Sheet(s) are completed and returned to the City.
If you have a completed smoke investigation checklist and smoke nuisance log sheet and agree to the above considerations, proceed to the next page to complete a noise investigation request.

Your Contact Details
Full Name*
Address*
Main Contact Number*
Alternative Contact Number
Email*
example@example.com
Address of Smoke*
Name of Person (if known)
Description of Issue
Experience has shown that in order to maintain harmonious relationships, it is better to contact the person causing the smoke before asking the City to become involved.
Have you attempted to resolve this matter yourself prior to contacting the City?*

YesNo
If yes, what was the outcome?

Declaration
I wish to lodge a smoke investigation request in relation to the details I have provided and acknowledge that:
- The City is subject to the Freedom of Information Act 1992
- All smoke complaints will be dealt with in order of priority
- Should legal action be necessary I may be required to give evidence in Court
- The City will not commence investigation of this request if a completed smoke log sheet and investigation checklist is not attached.
Attach Supporting Documentation*

Completed Smoke Investigation Checklist and Nuisance Log Sheet.
Cancelof
Signature*

Clear
Date*

DayMonthYear
Should be Empty:

Smoke Nuisance Investigation Request

Your Contact Details

Declaration