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Food Complaint

Disclaimer: If you choose to remain anonymous, we will not be able to follow up with you on this complaint. Additionally, we may not be able to pursue the complaint if we do not have all of the pertinent information. We do not share plaintiffs’ names with businesses unless further litigation is warranted

Complainant First Name

Complainant Last Name

Complainant Phone Number

Complainant Email

Complaint Information

Business Name

(Optional) Employee Name – if Complaint is Regarding a Specific Employee

Date of the Incident

Time of the Incident

Description of the Complaint

(Optional) List All Food and Beverages Consumed at time of Complaint – If you Believe a Foodborne Illness Occurred

Would You Like a Follow Up Call from the Investigator?

Yes

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