Food Poisoning Claim Registration Form
| Guest's name | |
|---|---|
| Address | |
| Number of affected by illness (Person, family, group) | |
| Number of people who consumed the same food (Person, family, group) | |
| Total number of services opened on the day of the complaint | |
| Phone No | |
| Date complaint started | |
| Time complaint started | |
| Duration of complaint |
Complaint Details
| Date | Time | Place |
|---|---|---|
Actions taken by the hotel
Form completed by
Signature:
Date:
Jacuzzi
Within 72 hours before the start of the complaint:
- Bath outside the room
- Swimming
- SPA
- Turkish bath
- Excursion
Symptoms
- Diarrhea
- Fever
- Headache
- Other symptoms (please specify):
Information about foods consumed within 72 hours before the start of the complaint
| Food | Abdominal pain | Date food was consumed | Time food was consumed |
|---|---|---|---|
Was there accommodation elsewhere before the hotel?
Information related to suspected illness
- Nausea
- Vomiting
Form No: FPR-tr