University of Kentucky | Tobacco-Free Policy

UNIVERSITY OF KENTUCKY TOBACCO-FREE POLICY

online violation report form

To report a violation of UK’s Tobacco-free Policy please fill out this form or send the information to: ReportTFviolation@uky.edu. Compliance is everyone’s business.

Date violator(s) observed:
Location violator(s) observed (be as specific as possible):	Location
Time violator(s) observed (format 00:00 AM/PM) i.e. 08:57 AM:
Number of violators observed at the location:
Description of violator(s). Give as much information as possible, e.g., male or female, clothing, glasses, hair color and style, facial hair, student, staff, visitor, vendor:	Description
Did you approach the violator(s) and remind of the tobacco-free policy?	Yes No
If yes, did the violator(s) comply with the tobacco-free policy?	Yes No
Please enter your email address if you would like to receive a follow-up response from our TFTA! Ambassadors (optional). All submissions will be kept confidential.	Enter your email address
Additional comments	Additional comments

Updated March 29, 2013 by Webmaster

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