In a world where safety and regulation compliance plays a critical role in the day-to-day operations of various entities, ensuring a streamlined process for reporting and addressing concerns is paramount. This importance is encapsulated in the use of forms like the SBD-192, also known as the Complaint Return Form, which serves as a vital tool for the public in the state of Wisconsin. Designed to facilitate communication between the public and the Safety and Buildings Division of the Wisconsin Department of Safety and Professional Services, this form allows individuals to raise issues ranging from amusement ride safety to commercial building and plumbing concerns. It notably prompts the reporter to provide thorough information about both themselves and the subject of the complaint, including details such as the complaint's nature, the desired outcome, and whether confidentiality is requested, underlining the state's commitment to both transparency and privacy per Open Records Laws. Additionally, it sets clear expectations about the division's jurisdiction, emphasizing that it does not cover contractual or leasing issues and directing such matters to the Wisconsin Department of Agriculture, Trade, and Consumer Protection. The form also highlights the division's discretion in investigating complaints and the potential for associated fees, conveying a balanced approach to addressing public safety and compliance concerns. With its comprehensive structure, the SBD-192 form embodies the procedural gateway for Wisconsin's residents to contribute to the safety and integrity of their surroundings, providing a structured path for their concerns to be heard and actioned upon.
| Question | Answer |
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| Form Name | Form Sbd 192 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | SPS, state of wi dsps, Quarries, Wisconsin |
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Complaint |
Return Form To: |
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Inspection and Safety Support Section |
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Registration |
P.O. Box 7302 |
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Fax: (608) |
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Madison, WI |
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Safety and Buildings Division |
Telephone: (608) |
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Email: DspsSbComplaintFiling@wi.gov |
Personal information you provide may be used for secondary purposes. [ Privacy Law, s.15.04 (l) (m)]
Contact your local municipal inspection department before submitting this complaint to the state.
Safety and Buildings has no jurisdiction over contractual or leasing issues. Please contact the Wisconsin Department
of Agriculture, Trade and Consumer Protection at
The department reserves the right to decide if a complaint will be investigated. Fees may be assessed to conduct the investigation in accord with SPS 302.04(2). You must provide your name and address when filing a complaint.
Complete Both Sides of Form
Your information: |
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Is confidentiality requested? |
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Name (please print): |
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Complaint |
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Open Records Laws) |
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Home: ( |
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Work: ( |
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Respondent Info |
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Site/Project Info |
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Name (who complaint is registered against): |
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Complaint Location (site/project name): |
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Street Address: |
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Street Address: |
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Daytime Telephone Number (include area code): |
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Complaint Involves the Following Program(s): |
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Amusement Rides |
Blasting |
Boilers/Pressure Vessels |
Commercial Building |
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Credentialing |
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Electrical |
Elevators |
Erosion Control |
Fire Safety |
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Manufactured Homes |
Manufactured Home Parks |
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Manufactured Housing Dealer |
Mines/Quarries |
Plumbing |
Pools |
Mechanical Refrigeration |
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Private Sewage Systems/Holding Tanks |
Public Safety |
Rental Weatherization |
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Storm Water |
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Gas Systems |
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Ski Lifts/Ski Tows |
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Plumbing Products |
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Other:__________________________________________________________________________________________________ |
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Have you worked with any other Safety and Buildings staff regarding this complaint/project? |
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No |
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To your knowledge, has this project been submitted to Safety and Buildings for review/approval? |
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No |
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If you answered yes to either of the questions above, please indicate who you worked with and any transaction/identification numbers assigned to it. Staff Name ___________________Transaction/identification numbers____________________
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Describe your complaint in detail. (Include copies of any papers involved in the complaint.
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How do you feel this complaint should be resolved? (Be specific)
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By submitting this complaint, I agree and understand that the information provided may be used in efforts to resolve your problem and will typically be shared with the party complained against. It may also be used to enforce applicable state laws. Under Wisconsin’s Open Records Law, this complaint will be available for public review upon request, after this department’s action if completed.
For Office Use Only
Investigation Transaction Number: ____________ |
Date Complaint Received: ______________ |
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Assigned/Referred to: ___________ |
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Code Sections |
Action taken: |
(Attach copy of inspection report or orders, if necessary). |
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_____________________________________________________________________________ |
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Entered By: ________________________________________________
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