BoH Complaint_Submission1393_2/6/2020 1:41:01 PM_ �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
1:41:01 PM
Complaint Type* Restaurant/Food
Street Number 95
Street Name* DERBY STREET
Unit Number
Occupant Name VFW
Parcel ID
Inspector Account SALEM\jorta
Ward 1
Land Use
Complainant Anonymous
Name*
Complainant Phone 555-555-1234
Number*
Complainant Email
Address
Comment:* Complainant states the food storage area in the basement is very
unsanitary. Meat was left in the grinder.The refrigerator in the food
storage area is filthy.
CITY OF SALEM,MASSACHUSETTS
BOARD OF HEALTH
98 WASHINGTON STREET,3RD FLOOR
TEL.(978)741-1800
Dgreenbaum@SALEM.COM