Contact Residential Environmental Health

Resident's details

1. Title Select... Mr Ms Miss Mrs Dr Other
2. First name
3. Last name

Resident's address and contact details

1. House number or name
2. Street name
3. Postcode
4. Landline number
5. Mobile number
6. Email

Landlord, owner or management agent's details

1. Landlord/letting agent name
2. First line of landlord/letting agent's address
3. Rest of landlord/letting agent's address
4. Landlord/letting agent's postcode
5. Landlord/letting agent's phone no.
6. Landlord/letting agent's email

Details of the complaint

1. What are the problems/complaints in the home you're reporting?
2. How long have these issues been occurring for?
3. When did you first report this to your landlord?
4. When was the last time you reported the matter to your landlord?
5. What did your landlord say about the matter?

Please answer the following questions only if you're contacting us about damp and mould in your home

1. Is there mould as well as dampness present?
2. Which rooms are the damp/mould in?
3. In each room, which walls are affected?
4. What percentage of the walls/ceilings are affected?
5. How long has the damp/mould been present?

   If it's since you moved into the property, simply state when you moved in

Additional details

1. Are you sharing any facilities with people who are not family members?
   • Yes
   • No
2. If Yes, what facilities do you share?
3. Do you receive any means-tested benefits?
   • Yes
   • No
4. If Yes, which benefits do you receive?
5. Does the household contain anyone 60 years old or older/14 years old or younger?
   • Yes
   • No
6. Are you a Residential Social Landlord or a Housing Association tenant?

   If 'Yes', please state which

7. Tenure Select... Freehold Leasehold Tenant
8. Is there anything else we should know?

   E.g. how these conditions affect your household's health

Energy Advice Team

1. Would you like to be contacted by our Energy Advice team?
   • Yes please
   • No thanks

1. 1. Submit form