BoH Complaint_Submission1392_2/6/2020 9:21:30 AM_ �ONDIT,� Board of Health Complaint form
This form captures submitted complaints for Salem's Board of Health
department to investigate.
9
�J,p�,�/M►niEoo� Fields with a * are required to be entered. Some fields are greyed
out but will auto populate from other field entries on the same form.
KIMBERLEY DRISCOLL
MAYOR
DAVID GREENBAUM,IRS
HEALTH AGENT
Date* 2/6/2020
9:21:30 AM
Complaint Type* Restaurant/Food
Street Number
Street Name* MARGIN STREET
Unit Number
Occupant Name Lifebridge
Parcel ID
Inspector Account SALEM\Jbarosy
Ward 3
Land Use
Complainant Anonymous
Name*
Complainant Phone 555-555-1234
Number*
Complainant Email
Address
Comment:* Volunteered last Sat and observed milk being used that was
expired, beef that he said was discolored that was being cooked for
meals, and thought he observed sewage backing up into the
kitchen sink.Also said bathrooms had feces on the floor.
CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
98 WASHINGTON STREET,3RD FLOOR
TEL.(978)741-1800
Dgreenbaum@SALEM.COM