Sample Customer Foodborne Illness Complaint Report Form 2026

1. Click ‘Get Form’ to open the Sample Customer Foodborne Illness Complaint Report Form in the editor.
2. Begin by filling out the 'Incident Log' section. Enter your name in the 'Taken by' field, followed by the facility name and date of the incident.
3. Provide your work and cell phone numbers for contact purposes. Next, fill in the customer's details including their name, address, postal code, and home phone number.
4. Indicate if other people were involved in the incident and specify how many. Record the date and time of the meal or food items consumed.
5. List any food items involved in the complaint and document when symptoms began, including both date and time.
6. Detail any symptoms reported by the customer. Indicate whether a food sample is available and where it can be found.
7. Answer questions regarding medical attention received by the customer, including if they saw a doctor or were hospitalized.
8. Complete follow-up actions taken by your facility, noting who performed them and how (phone call, letter, etc.).
9. Finally, ensure that all information is accurate before saving or exporting your completed form securely.

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