Please complete this form if you wish to report a foodborne illness for yourself or on behalf of someone else in your household. We use this information to detect outbreaks of foodborne diseases. Generally, it takes about 5-10 minutes to fill out a complete report.

Privacy Information:

  • This report is completely voluntary.
  • All personal information will be kept confidential.
  • The appropriate state or local health department will be notified of your complaint and may initiate a facility inspection.
  • If an outbreak is identified, the state or local health department may follow up with you to collect more information.
Loading... Loading...
You have selected an option that triggers this survey to end right now.
To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.