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Virtual Tobacco Retail Inspection Interest Form
Use the form below to express your interest in a virtual tobacco inspection for your store.
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Email
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Your email
Virtual Inspection Opportunity
Allowing an annual routine inspection is a responsibility of your Tobacco Retail License (TRL). The TRL program is now offering a virtual inspection option to safely help your store meet compliance while helping to slow the spread of COVID-19.
More Information
Tobacco Control and Prevention Program
503-988-4163,
hlth.tobacco.prevention@multco.us
https://multco.us/health/inspections-and-licensing/tobacco-retail-license
Name of store:
*
Your answer
Tobacco Retail License Number:
*
Your answer
Contact Information
Name of Main Store Contact (this person would help schedule the virtual inspection):
*
Your answer
Main Contact Phone Number:
*
Your answer
Main Contact Email Address:
Your answer
Is there a best time of day to reach the main contact?
*
Mornings (before 10am)
Mid morning (between 10am-12pm)
Afternoon (12pm-4pm)
Evening (after 4pm)
Other
If other, please enter the best time to reach the main contact.
Your answer
Will the main contact be the designated representative for the store during the virtual inspection?
*
Yes
No
Not sure
Interpretation Assistance
Please note: Interpretation services are provided at no cost.
Would the main contact like to request an interpreter? If yes, please let us know the language.
Spanish
Korean
Chinese
Vietnamese
Russian
Somali
Other:
Clear selection
Virtual Inspection: Consent to Video Recording
Please be aware that if you choose to schedule a virtual inspection, you are consenting to a video recording which will be made during the inspection
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