/Foodborne Illness Complaint Form

Foodborne Illness Complaint Form

Foodborne illness is often called food poisoning. It occurs when someone becomes ill after eating a food or drinking a beverage contaminated with a harmful substance. If you believe your illness was caused by eating at a commercial food establishment (such as a restaurant, deli or caterer) complete the Foodborne Illness Complaint Form below. Otherwise, click here to learn about other ways to report foodborne illness.

Contact Information - Step 1 of 4

* Are you one of the people who became ill?

Establishment Information - Step 2 of 4

Information About Patient No. 1 - Step 3 of 4

Please provide the following information about the ill person

Symptoms for Patient No. 1 - Step 3 of 4

Medical Care Information for Patient No. 1 - Step 3 of 4

Did the person receive

Report Summary

Please verify your information below.

Enter in the establishment name and / or the Hotel and Street Names if known. We will try to locate the proper establishment for this report.

If you are unable to find the correct establishment, please fill in as much of the above information you can and click the "Unable to Find" button below.

Location Map

Updated on: February 18, 2022

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