Get the free Foodborne Illness Investigation Form Part II - Field Investigation - doh wa

Washington State Department of Health Foodborne Illness Investigation Form Part II Field Investigation Please Print Jurisdiction: Field Investigator Name: Facility Name and Address: Local Health Case

How to fill out foodborne illness investigation form

How to fill out a foodborne illness investigation form:

1. Start by providing your contact information: Fill in your name, address, phone number, and email address. This will help the authorities to reach out to you if they need further information.
2. Specify the date and time of the suspected foodborne illness: Indicate when you started experiencing symptoms and when you consumed the potentially contaminated food. This will help investigators trace the source of the illness.
3. Describe your symptoms in detail: Write down all the symptoms you experienced, such as nausea, vomiting, diarrhea, stomach cramps, fever, or any other relevant signs. Be as specific as possible to help identify common symptoms in multiple cases.
4. Detail your food consumption: List all the foods you consumed during the period leading up to the illness. Include the names of the dishes, where you ate them (restaurant, home-cooked, etc.), and any specific ingredients or brands you remember. Remember to mention any additional people who consumed the same food and also fell ill.
5. Mention any medical treatment sought: If you sought medical attention or took any medication for your symptoms, provide details about the healthcare provider you visited, their contact information, prescribed treatments, and any tests conducted.
6. Preserve any leftover food: If you still have any leftovers from the potentially contaminated food, it is important to keep them refrigerated for potential testing. Make sure to mention this in the form and follow any additional instructions provided by the authorities.

Who needs a foodborne illness investigation form?

1. Restaurants and food establishments: It is crucial for businesses in the food industry to fill out a foodborne illness investigation form if a customer reports an illness. This helps the authorities identify potential outbreaks and take necessary actions to prevent further cases.
2. Individuals experiencing foodborne illnesses: If you suspect that your illness is a result of consuming contaminated food, it is essential to fill out a foodborne illness investigation form. This ensures that your case is properly documented and investigated, potentially preventing others from falling ill.
3. Medical professionals: Physicians, nurses, and other healthcare providers who come across patients exhibiting symptoms of foodborne illnesses should encourage them to fill out a foodborne illness investigation form. This allows for better tracking and control of outbreaks.

Overall, anyone directly or indirectly involved in a case of suspected foodborne illness should consider utilizing a foodborne illness investigation form. It serves as a valuable tool in investigating and addressing potential outbreaks, protecting public health, and ensuring food safety.

For pdfFiller’s FAQs

What is foodborne illness investigation form?

The foodborne illness investigation form is a document used to report cases of foodborne illnesses in order to track and investigate outbreaks.

Who is required to file foodborne illness investigation form?

Food service establishments, healthcare providers, and laboratories are required to file foodborne illness investigation forms.

How to fill out foodborne illness investigation form?

The form can be filled out online or submitted through mail, and must include details about the affected individual, symptoms, possible sources of contamination, and any other relevant information.

What is the purpose of foodborne illness investigation form?

The purpose of the form is to help identify and address foodborne illness outbreaks, prevent future cases, and protect public health.

What information must be reported on foodborne illness investigation form?

Information such as the name and contact information of the affected individual, symptoms, suspected food sources, and any medical treatment received must be reported on the form.

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