Location of possible breach: (eg. Business Name) *
Address: (eg. Surfers Paradise)*
Business phone: (If applicable)
Select From Type:
More than one smoking product display Size of smoking product display (i.e. more than 1sqm or 3sqm for tobacconists) Manner of display of smoking products Cartons of smoking products on display Retail prices Promotion of smoking products Other
False Representation of Age Location of Tobacco Vending Machine Other
Date of possible breach: * (DD.MM.YYYY)
Time of possible breach: (If observed): am pm
Description of situation in which possible breach occured: *
Please provide your details in the event a Queensland Health officer may need to contact you to clarify any information you provide.
Name:
Phone:
E-mail:
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Last Updated: 13 March 2009 Last Reviewed: 13 March 2009
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