1 Current Page 1 2 Preview 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? - Select -YesNo Nature of Complaint What is the problem you are experiencing? For example: no heat, no water, leaking roof, rodent/insect infestation Math question 8 + 5 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.