Allergy Incident Report

RIT Dining and the RIT Office of Compliance and Ethics take every complaint of allergy incidents seriously. In order to help us investigate your concerns, please fill out this form. Once received, our team will contact you for additional information.

Name

Status

Phone Number

Email Address

Please list known allergies:

At what restaurant or event did you eat?

List all foods and beverages consumed at this meal

What are your symptoms?

Was an EpiPen or other medication administered?

How many doses were administered?

Have you been in contact with RIT Dining's Registered Dietician?

Was medical help sought?

Please provide the name of the treatment center, as well as the time and date visited.

Additional Information