Rental Accommodation Inspection Request

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Personal information on this form is collected under the authority of section 23 of the Public Health Act, R.S.P.E.I., Cap. P-30.1, and the Rental Accommodation Regulations under that Act. If you have any questions about the collection or use of this personal information, you may contact Environmental Health, at 902-368-4970 or toll-free at 1-800-958-6400.

Identification

Enter the tenant's information in the fields below.

First Name

Middle Initial

Last Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example C1B 0X1 or 12345

Country

Telephone Number

For example 902-555-5555

Email Address

Landlord's Information

Enter the landlord's information in the fields below.

Business/Organization Name

Contact Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example: C1B 0X1 or 12345

Country

Telephone Number

For example 902-555-5555

Email Address

Complaint Information

Have you notified the landlord of this complaint and provided an opportunity for action?

Nature of Complaint

What is the problem you are experiencing? For example: no heat, no water, leaking roof, rodent/insect infestation

CAPTCHA

Math question 19 + 1 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.