Get the TOBACCO/SMOKE FREE AFFIDAVIT

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HUMAN RESOURCES DEPARTMENT BENEFITS SECTION TOBACCO/SMOKE FREE AFFIDAVIT Rev: 1 Date: 01/03/2019 Print Date: 01/03/2019NOTE: This affidavit does not apply to NonMedical Plan employee participants

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How to fill out tobaccosmoke affidavit

01

To fill out a tobacco smoke affidavit, follow these steps:

02

Start by writing the date at the top of the form.

03

Then, enter your personal information, such as your name, address, and contact information.

04

Identify the property or location where the tobacco smoke is a concern.

05

Provide details about the issue, including the frequency and duration of exposure to tobacco smoke.

06

If applicable, mention any health concerns or symptoms experienced due to the exposure.

07

Indicate if you have made any attempts to resolve the issue with the responsible party.

08

Sign and date the affidavit at the bottom.

09

Remember to review the form for accuracy before submitting it.

Who needs tobaccosmoke affidavit?

01

A tobacco smoke affidavit may be needed by individuals who are experiencing exposure to tobacco smoke in a specific location, such as a residential property, workplace, or public space. This affidavit can be used to document the issue and communicate the concern to the appropriate authorities or responsible parties.

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What is tobaccosmoke affidavit?

A tobaccosmoke affidavit is a legal document that certifies whether a location is compliant with laws regarding smoking tobacco within enclosed spaces.

Who is required to file tobaccosmoke affidavit?

Typically, property owners, landlords, or managers of public spaces where tobacco use may occur are required to file a tobaccosmoke affidavit.

How to fill out tobaccosmoke affidavit?

To fill out a tobaccosmoke affidavit, individuals must provide accurate information about the property, the smoking policy in place, and affirm their compliance with applicable tobacco laws.

What is the purpose of tobaccosmoke affidavit?

The purpose of the tobaccosmoke affidavit is to ensure compliance with health regulations regarding smoking and to help protect public health by controlling tobacco use in enclosed spaces.

What information must be reported on tobaccosmoke affidavit?

The affidavit generally requires information such as the name and address of the property, the smoking policy, any designated smoking areas, and the signatures of responsible parties.

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