Get the free FOOD ILLNESS REPORT FORM

COUNTY OF SAN LUIS OBISPO HEALTH AGENCY ENVIRONMENTAL HEALTH SERVICES DIVISION2156 Sierra Way STE. B, San Luis Obispo, CA 93401 PO Box 1489, San Luis Obispo, CA 93406 Phone: (805) 7815544 Fax: (805)7814211 Email:

How to fill out food illness report form

How to fill out food illness report form

1. Start by gathering all the necessary information such as your personal details, including name, contact information, and address.
2. Provide details of the food establishment where you suspect the illness originated, including name, address, and contact information if available.
3. Specify the date and time of your visit to the food establishment.
4. Describe the food items you consumed and suspect caused the illness, including the name, description, and any relevant details like expiration dates or preparation methods.
5. Provide a detailed account of your symptoms and when they started, including any additional information such as fever, vomiting, or diarrhea.
6. If applicable, mention whether others who shared the same meal or visited the same establishment also experienced similar symptoms.
7. Attach any relevant supporting documents, such as medical records or receipts from the food establishment.
8. Submit the completed food illness report form to the appropriate authority, such as the local health department or food safety department.

Who needs food illness report form?

1. Anyone who has experienced a foodborne illness and wants to report it to the authorities.

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What is food illness report form?

The food illness report form is a document used to report incidents of foodborne illnesses.

Who is required to file food illness report form?

All food establishments, healthcare providers, and individuals who suspect foodborne illnesses are required to file a food illness report form.

How to fill out food illness report form?

The food illness report form must be completed with information such as the person's contact details, symptoms experienced, food consumed, and any relevant medical history.

What is the purpose of food illness report form?

The purpose of the food illness report form is to track and investigate incidents of foodborne illnesses to prevent further outbreaks.

What information must be reported on food illness report form?

Information such as the date of onset of symptoms, location where food was consumed, and any contact with other individuals experiencing similar symptoms must be reported on the food illness report form.