Javascript must be enabled to complete this form. Please see https://www.enablejavascript.io for more information.
Please provide us with the information below. Your information is confidential and will be seen only by Manitoba Health, Seniors and Active Living staff. Fields marked with a red asterisk are required.
If you wish to speak directly to a Public Health Inspector, or to remain anonymous, please phone the Health Protection Office in your area using the numbers at the bottom of this page.