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2. 

   For any questions please contact Nye County Incident Reporting and Management at IncidentReporting@nyecountynv.gov

4. Your Name*
5. Today's Date*
   Today's Date
7. Street Address, Town, Zip Code*
9. Mailing Address (If Different From Above)
11. Email*
12. Phone
14. Details of Complaint*
16. Location of Incident*
17. Date of Incident*
    Date of Incident
19. Provide a detailed description of the incident, including any relevant facts, events, or actions that have led to the complaint:*
21. State the specific outcome you are seeking because of this complaint:*
23. Attach or include any supporting documents or evidence that may be pertinent to the complaint. This may include photographs, videos, correspondence, or any other relevant records.
24. NOTE: You will be redirected to the Risk Management Office page after hitting submit.
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit Submit and Print

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