Anonymous Food Complaint Form

 Step 1 of 1

If you have a suspected foodborne illness, please call the Health Department directly at 765-342-6621 and ask to speak to a food inspector.

Please Note: For complaints of a suspected foodborne illness, please call the Health Department as soon as possible and ask to speak to a food inspector. If you are still symptomatic or if you have leftover suspect food, the Health Department may ask you for a sample.

The Health Department may ask for some or all of the following details:

  • What was eaten, including beverages, condiments and dessert
  • Symptoms
  • Date and time of meal and when symptoms began and ended
  • Details/locations of meals for 3 days prior to suspected meal
  • Name of facility or product
  • Number of people affected
  • Doctor/hospital information if applicable
  • Activities of the ill person, including, for example: do you use well water, have you attended any potluck meals recently, have you been swimming recently, or any handling of farm animals

* Denotes a required field
Please note that food complaints can be submitted anonymously. You are NOT required to include your email address.
 
 
Part A: For a complaint with a specific establishment, please fill out the section below. 
 
 
 
 
 
ZIP 
-
Second portion of ZIP Code is optional.
Date of Visit*
 , 
Time of Visit 
 :  
 
Part B: For a complaint regarding a specific food, please fill out the section below. 
 
When Purchased: 
 , 
 
 
 
 
Did anyone become ill? 
OPTIONAL: Phone Number (if you want the Health Department to contact you regarding a possible foodborne illness): 
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