Alleged Food Poisoning Report

Confidential Incident Investigation Form

1. Customer Information

Customer Name

Contact Number

Email Address

2. Incident Details

Date Food Consumed

Time Food Consumed

Food Items Consumed (Be Specific)

4. Internal Investigation & Due Diligence (Office Use)

CCP Validation (Cooking/Hot Holding)

Retained Samples

Staff Sickness Review

EHO Notified?

Detailed Action Taken / Root Cause Findings

HFS SCIENTIFIC NOTE: Incubation periods are vital for identification. Staphylococcus aureus typically acts within 1–6 hours, while Salmonella usually requires 12–72 hours. Always ask the customer what they ate in the 48 hours prior to visiting your establishment.

REPORT STATUS: AWAITING INPUT