Food Safety Complaint Form 2

Food Safety Complaint Form

Please fill out each section completely and accurately.
Franklin County Public Health does NOT have jurisdiction over the City of Columbus or the City of Worthington.

💡 If the property/business is located within the City of Columbus or the City of Worthington, do not complete this form. Instead, please go to https://311.columbus.gov/ to file a complaint. Not sure? Check the address at: https://gis.columbus.gov/zoning/. 💡

Please Note: This form becomes a public record after it is submitted.
Location Name *
Business Name
Complaint Location*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
City, township or village
Did you get sick?*

YesNo
Food(s) Eaten
Date Eaten

MonthDayYear
Date
Onset of Symptoms

MonthDayYear
Date
Symptoms

Upset stomach/stomach acheVomitingDiarrheaFeverOther
End of Illness/Symptoms

MonthDayYear
Date
How many people were sick?
What concerns did you have about the food establishment?

Insects or RodentsCleanlinessStaffFood PreparationNoneOther
Please provide a detailed description of the complaint*
Upload Picture
Upload Picture
Additional Complaint Documentation

Cancelof

Please provide the best day(s) and time(s) you're available for us to contact you.

Please Note: Providing your contact information will help our investigation; however, this form becomes a public record after it is submitted. If you prefer to submit your complaint verbally, call (614) 525-5258.
Your Contact Information

Name

Street Address

CityState / Province

Postal / Zip Code
Phone Number
E-mail
example@example.com
To see the inspection report from your complaint please click the link below after 48 business hours here. If your complaint was in the City of Columbus please contact Columbus Public Health on any follow-up action taken on the complaint.
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