Food complaint
Required hidden information
Queue Record Id
Record Type
AccountID
GazeteerID
Customer details
Your name
Email
Phone number
Details of establishment
Name of food establishment to which problem relates / place of purchase
Address of food establishment
Nature of Food Problem
Nature of problem
Food containing a foreign body
Food poisoning
Food labelling (including out of date food)
General hygiene concerns
Accumulation of refuse (food)
Unhygienic practices
Unhygienic premises
Problem with food item
Description of food
Description of problem, including how discovered
Date of purchase
Do you still have the food item and where applicable packaging showing manufacturers details / codes etc ?
Yes
No
Officer will contact to discuss possible collection / viewing of item if necessary.
If product is perishable or mouldy / rotten etc keep in freezer.
It is unlikely we will be able to investigate but will note on our file for information
Food labelling
Purchase date
Use by date
Description of food
Details of out of date food or labelling
Do you have product ?
Yes
No
Please keep the item in freezer.
An officer will contact you to discuss possible viewing /collection if necessary.
Food poisoning
Date and time food was eaten
Date and time symptoms started
Details of food items eaten
Description of symptoms
Please also state whether you have had tests (e.g. submission of stool specimen) to confirm the cause of illness.
Are you still ill?
Yes
No
Has anyone else been ill?
Yes
No
Please add any further information that you think may be helpful
General Hygiene concerns
Description of problem
Additional information
Additional details
Upload evidence
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