Report a Food-Related Issue

CDC Guidance on Food Poisoning Symptoms

File a Complaint Report a Foodborne Illness

Case Details

Items marked with an * are required.

Were you eating at home or a restaurant?

Home Restaurant

Where did you purchase the food?*

What is the store's address?

What type of food did you eat?*

When did you eat it?*

What happened?

How many people got sick?*

Contact Information

The Food Safety Program would like the following information in order to contact you directly, if needed.

Name:

Phone Number:

Email:

File a Complaint

Items marked with an * are required.

Your Information

Confidentiality:

Any contact information you provide is protected private information. This information can prove extremely helpful in investigating complaints but you are not required to provide it. Do you want your complaint to be anonymous? Yes No

Name:

Address:

Email:

Home Phone:

Daytime Phone:

Establishment Information

Establishment Name*:

Establishment Address*:

Complaint

Date/Time Observed*:

Complaint Type:

Complaint*: