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Foodborne Illness

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Please correct the field(s) marked in red below:

Please use the following form to make a foodborne illness complaint. Please fill out as much of this form as possible and the investigating sanitarian will contact you to ask follow-up questions.

 

1
Please enter your contact information
 *
Please enter your contact information
2
Please enter information about the location of the complaint
Please enter information about the location of the complaint
3
Please explain the issue (include as much information as possible)
4

Date of Meal:

 *
Date of Meal:
5
Start of Symptoms:
Start of Symptoms:
6
End of Symptoms:
End of Symptoms:
7
Symptoms:
Symptoms:
8
Medical Attention
Medical Attention
9
Please make sure that your contact information is accurate. A sanitarian will be calling you to get more information. 
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