Food Reaction Reporting Form
All members of the public are invited to report incidents of Food Reactions when food is consumed at home, in food establishments, cafeterias, social gatherings, vacation resorts, kids camps, hotels, motels, in-transit on the plane, train or traveling buses, and other areas where food is prepared, served or from packaged foods, beverages and drinks. The Canadian Food Safety Institute (CFSI) collects, organizes and analyzes this information to a) develop community food safety programs and b) share with public and community health organizations by official request or when necessary. This information is internal to CFSI and will not be shared with or distributed to other organizations. Thank you for participating in the Food Reaction Reporting Initiative. Please click on the Submit button to submit the form details.
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First Name:
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Food Consumed:
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Date Food Consumed:
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Time Food Consumed:
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Brief Description of Food Reaction:
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Your Email Address:
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Your Phone Number (Only if we need to follow up:
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Other information relevant to this Food Reaction:
Please click on the Submit button to submit the form details.
© Canadian Food Safety Institute, 2009
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