Food complaints form

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Email *

Section 2: about the food (if you are complaining that you suffered from food poisoning after eating the food, you will need to provide a stool sample to your GP to identify the organism involved. We will investigate only after we have received a positive result)

Type of food

Nature of the Complaint

Do you still have the food item?

Where did you buy the item?

Date of purchase

Use-by date and batch number (if applicable)

What was the business’s response to your concerns?

Were you offered a refund or other compensation (for example, a replacement meal or free drink)?

If you still have the food, an officer may need to visit you at home as part of the investigation. In most cases, however, we will ask you to bring the food into the council offices. Once we have received your form, we will tell you whether we need you to do this.

Date