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 *

Month

Day

Year

Time of Consumption *

Hour

Minute

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 *

Month

Day

Year

Time of illness onset *

Hour

Minute

What are your symptoms? *

Was medical help sought? *

Was lab testing done? *

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

Additional Information

Search form

Foodborne Illness Report