Town of Fairhaven, MA - WIND TURBINE IMPACT COMPLAINT FORM

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Town of Fairhaven, MA

WIND TURBINE IMPACT COMPLAINT FORM


	THE FAIRHAVEN BOARD OF HEALTH 40 Center Street, Fairhaven, MA 02719 BOH@fairhaven-ma.gov 508-979-4022

Location: (effects observed INSIDE a building)

Checkboxes	Checkbox Description	Checkboxes	Checkbox Description
	North interior		Basement
	South interior		1st floor
	East interior		2nd floor
	West interior		3rd floor
	Windows open		All interior locations

Please provide the following information:

Field Description	Field Data	Required Field
Complainant Name:		required
Email:		required
Complainant Address		required
Complainant Telephone:
Date and time of event:
Duration of event:

Location of event was: (Please check one/and add address in the field provided below)

Residence
Commercial site/building
School
Public area

Nature of event:

If you chose other please indicate below:

Describe intensity of above on a scale of 1 to 10 with 1 being no change, 10 being unable to perform normal activities at the location. Describe the intensity for each nature of event that has been checked above.

Impact of observed effects on you:

Describe intensity of above on a scale of 1 to 10 with 1 being no change, 5 being uncomfortable, 10 being intolerable (unbearable)

Addition comments:

With whom may this information be shared?

Field Description	Field Data
Privacy: The Board of Health will maintain these records. All personal information will remain confidential. The owner of the wind turbines will be contacted about the nature of the complaints. This information is confidential and will not be shared unless express permission is granted by the complainant.