Home Isolation Violation Report

.Report a violation of the Home Isolation Decree issued by the State of Israel Ministry of Health

*Fields marked with an asterisk are mandatory.

First and last names of the person filling out this form

The email address of the person filling out this form

The telephone number of the person filling out this form

* First and last name of the offender

The address of the offender

* Place of residence of the offender

The main telephone number of the offender

?Any remarks regarding the main telephone number

(Another telephone number of the offender (if available

?Any remarks regarding the additional telephone number

Elaborate on the violation, and mention the date of arrival in Israel (next text box)

The date of arrival in Israel

?Have you reported this violation in the past

Yes

No

Leave this field blank