Warren County Health District
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If you have Food Operation Complaint for us, please complete the form below and we’ll contact you as soon as possible:
Name of Food Operation (required)
Operation Address (required)
Details of Complaint (required)
When did situation occur? (required) Date/Time
Did you discuss the situation with the operator? ---YesNo
What was their reaction?
If complaining of illness, what were the symptoms? N/ACrampsDiarrheaNauseaVomitingHeadacheChillsFeverBody Aches
Any other symptoms?
What did you eat? Include any items eaten at suspect meal including sauces, dressings, and beverages.
When did the symptoms begin?
When did you being to feel better?
Was a physician consulted? ---YesNo
Were you hospitalized? ---YesNo
Was any one else ill? ---YesNo
Your name
Age
Sex ---FemaleMale
Your Address
Your Phone Number
Your Email
