Environmental Laboratory Accreditation Home Page

Complaint Form

Use this form to notify the Minnesota Department of Health (MDH) Environmental Laboratory Accreditation Program about laboratory activities or the quality of data produced by a certified laboratory that may required MDH attention.

Section 1 and 2 of the Complaint Form must be completed before any type of investigation can occur. No investigation will occur without these sections being completed. In Section 3, we are requesting your name and phone number so that we may contact you if further information is necessary. You have the option of indicating if you want to be contacted to let you know how your complaint was handled. You are not required to supply identifying information. If you do provide identifying information, it will be treated as confidential information and can only be released to MDH employees who need it to process your complaint, department representatives in the Attorney General's Office, the courts, and anyone having a court order to obtain the information.

This form is designed to improve public access to the MDH. Submitting it to us is voluntary.

*Section 1:*
Laboratory name:	required
Certification # (if applicable):
Address:
City:	required
State:	required
Zip:

*Section 2*:
	Please check all that apply to your complaint.
	Programs(s): clean water safe drinking water RCRA UST unknown
	Observations and Concerns: Inadequate quality control Inadequate documentation Data not qualified Inappropriate MDL Not using an approved method Other (please specifiy):
	Please describe in detail the nature of the complaint/concern. Please describe any supporting documentation you have which may assist us in our investigation.

*Section 3:*
	INFORMATION ON COMPLAINANT
Name:
Organization:
Address:
City:
State:
Zip:
Phone:


	To prevent abuse of this form, please type the following letters/numbers EPSMF into the field below. Thank you required