Complaint Form

Please note that a copy of this complaint could be provided to the individual(s) involved in your complaint. Also, you could be called to testify as part of a formal or informal proceeding, such as a hearing. Complaints filed with the Arizona Board of Technical Registration are subject to the Public Information Act. In most cases, the Board must disclose the information you provide on the complaint form to any person who requests it, including the person against whom you are filing this complaint. If you have any concerns about the disclosure of your personal information (name, address, etc.), please contact the Board before you file this complaint form and we can discuss it with you.

The Board has the statutory authority to issue restitution (for the cost of a home inspection or an engineering report, etc.). Restitution is not the same thing as Damages. Damages could be received by pursuing a cause of action in Justice or Superior Court.

Your Information

Your Name *

Per A.R.S. § 41-1010; "Notwithstanding any other law; a person shall disclose the person's name during the course of reporting an alleged violation of law or rule. During the course of the investigation or enforcement action, the name of the complainant shall be public record unless the affected agency determines that the release of the complainant's name may result in substantial harm to any person or to the public health or safety."

Home Phone Number

Cell Phone Number

Fax

Mailing Address

City

State

Zip

Business Name

Business Phone

Subject of the Complaint

Name of individual you are complaining about

Name of Company

Individual’s profession & Registration No.

Address

City

State

Zip

Work Phone

Home phone

Website Address

Project Name and Location

Please provide the information below regarding persons who can help provide information related to the alleged violation(s) you are reporting in this complaint:

Witness 1

Witness name

Address

Phone

Witness 2

Witness name

Address

Phone

What would you like the Board to accomplish in resolving your complaint?

Please note that upon receipt of a complaint, the Board will conduct a preliminary evaluation of the matter to determine whether allegations described in your complaint are within the Board’s jurisdiction. Please review the statutes and rules enforced by the Board on our Website to ensure that you provide sufficient information and to ensure that the allegations are of a law within the Board’s jurisdiction (www.azbtr.gov). You may call (602) 364-4930 to request to speak to someone in the Enforcement Unit.

Description of Your Complaint

Be specific. What happened? Who was involved, including city or county agencies (provide names, addresses and phone numbers)? Provide dates and details / timeline of events. Clearly describe each alleged statute and/or rule violation separately and enclose copies of any documents from any sources which will support your allegations. Include the date the incident(s) occurred and the address of the location where the incident(s) occurred.

Attachments

If you have more than 10 files to include, please submit a second form.

File 1

More information