Foodborne Illness Report

RIT’s Office of Compliance and Ethics takes every complaint of foodborne illness seriously. In order to help us investigate your concerns, please fill out this form. Once received, our office will contact you for additional information.

Name

Status

Phone Number

Date of Consumption

Time of Consumption

At what restaurant or event did you eat?

List all foods and beverages consumed at this meal

In the last 72 hours prior to your illness, please list all other locations where food was consumed

Date of illness onset

Time of illness onset

What are your symptoms?

Was medical help sought?

Was lab testing done?

If you ate with other people, are they also ill?

Additional Information