Foodborne illness forms

Division of Food Protection (DFP) forms related to foodborne illness

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Foodborne illness complaint worksheet

Use the Report My Meal online form to submit a suspected foodborne illness. The page explains what information to gather, how to complete the form, and what happens after your report is reviewed by public health officials.

Report My Meal

Stool collection for bacteriology testing

Open PDF file, 54.67 KB, Stool Collection for Bacteriology Testing Instructions (English, PDF 54.67 KB)

Open RTF file, 88.21 KB, Stool Collection for Bacteriology Testing Instructions (English, RTF 88.21 KB)

"How to Collect a Stool Specimen" training video

Open PDF file, 273.39 KB, Stool Instructions Handout - English (English, PDF 273.39 KB)

Open DOCX file, 1.08 MB, Stool Instructions Handout - English (English, DOCX 1.08 MB)

Open PDF file, 273.67 KB, Stool Instructions Handout - Spanish (English, PDF 273.67 KB)

Open DOCX file, 1.08 MB, Stool Instructions Handout - Spanish (English, DOCX 1.08 MB)

Environmental sample submission form

Open PDF file, 316 KB, Environmental sample submission form (English, PDF 316 KB)

Open RTF file, 322.14 KB, Environmental sample submission form (English, RTF 322.14 KB)

Foodborne illness investigation task list

Open PDF file, 19.37 KB, Foodborne Illness Investigation Task List (English, PDF 19.37 KB)

Open DOC file, 29.5 KB, Foodborne Illness Investigation Task List (English, DOC 29.5 KB)

HACCP risk assessment form

Open PDF file, 18.32 KB, HACCP Risk Assessment Form (English, PDF 18.32 KB)

Open DOC file, 58 KB, HACCP Risk Assessment Form (English, DOC 58 KB)

National Environmental Assessment Reporting System (NEARS)

Open PDF file, 1.03 MB, NEARS - For Regulatory Agencies Only (10/28/2020) (English, PDF 1.03 MB)

Open DOCX file, 129.62 KB, NEARS - For Regulatory Agencies Only (10/28/2020) (English, DOCX 129.62 KB)

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