Establishment Name: _____________________________
Date of Report: _______________
Incident Reference No.: _________________________
Priority Level: ☐ Low ☐ Medium ☐ High
SECTION 1 — INCIDENT DETAILS
# | Checklist Item | ✔ | Notes |
1.1 | Record the exact date and time the complaint was received | ☐ | |
1.2 | Record the guest's full name and contact details (phone & email) | ☐ | |
1.3 | Record the name and position of the staff member receiving the complaint | ☐ | |
1.4 | Record the method of complaint (phone/email / in-person/online review) | ☐ | |
1.5 | Record the total number of affected guests | ☐ | |
1.6 | Record the date and time of the original visit/dining occasion | ☐ | |
1.7 | Record the table number, booking name, or reservation reference | ☐ |
SECTION 2 — GUEST & SYMPTOM INFORMATION
# | Checklist Item | ✔ | Notes |
2.1 | Record all symptoms reported (nausea, vomiting, diarrhoea, cramps, fever, etc.) | ☐ | |
2.2 | Record the time symptoms first appeared | ☐ | |
2.3 | Record the duration of symptoms | ☐ | |
2.4 | Confirm whether the guest sought medical attention and obtain details if so | ☐ | |
2.5 | Record all known food allergies and dietary requirements | ☐ | |
2.6 | Record all food and beverages consumed at the establishment | ☐ | |
2.7 | Record approximate consumption times for each item | ☐ | |
2.8 | Ask whether the guest consumed food or drink elsewhere within 72 hours | ☐ | |
2.9 | Ask whether other members of the same party are also affected | ☐ | |
2.10 | Ask whether the guest has any pre-existing medical conditions relevant to the complaint. | ☐ |
SECTION 3 — FOOD & BEVERAGE INVESTIGATION
# | Checklist Item | ✔ | Notes |
3.1 | Identify all menu items consumed by the affected guest(s) | ☐ | |
3.2 | Verify that preparation procedures were correctly followed for each item | ☐ | |
3.3 | Verify that the correct cooking temperatures were reached and recorded | ☐ | |
3.4 | Verify holding and storage temperatures at the time of service | ☐ | |
3.5 | Check expiry/use-by dates of all ingredients used in suspect dishes | ☐ | |
3.6 | Identify all staff involved in the preparation, plating, and service of the items. | ☐ | |
3.7 | Check whether any other guests on the same day ordered the same items | ☐ | |
3.8 | Check whether any similar complaints have been received in the past 7 days | ☐ | |
3.9 | Review supplier delivery records for freshness and cold-chain compliance | ☐ | |
3.10 | Verify that no substitutions or unapproved ingredient changes were made | ☐ |
SECTION 4 — KITCHEN & SAFETY INSPECTION
# | Checklist Item | ✔ | Notes |
4.1 | Inspect all relevant food storage areas (dry, refrigerated, frozen) | ☐ | |
4.2 | Record current refrigerator and freezer temperatures | ☐ | |
4.3 | Verify cleaning and sanitation logs are up to date | ☐ | |
4.4 | Confirm that handwashing procedures were followed by all food handlers | ☐ | |
4.5 | Check for evidence of cross-contamination between raw and ready-to-eat foods. | ☐ | |
4.6 | Review pest control records and inspect for signs of pest activity | ☐ | |
4.7 | Check that all cutting boards, utensils, and surfaces were sanitised correctly.y | ☐ | |
4.8 | Verify that staff on duty held valid food safety/hygiene certificates | ☐ | |
4.9 | Check that single-use gloves were used where required | ☐ | |
4.10 | Inspect dishwashing equipment temperatures and sanitiser concentrations | ☐ |
SECTION 5 — DOCUMENTATION & REPORTING
# | Checklist Item | ✔ | Notes |
5.1 | Save copies of the guest's receipts and/or order records | ☐ | |
5.2 | Preserve a sealed sample of the suspected food item(s) if available | ☐ | |
5.3 | Take dated photographs of implicated food, equipment, or storage areas | ☐ | |
5.4 | Notify restaurant/venue management immediately | ☐ | |
5.5 | Determine whether reporting to health authorities is legally required | ☐ | |
5.6 | Submit a formal notification to the health authorities if required | ☐ | |
5.7 | Complete the internal incident report form | ☐ | |
5.8 | Log the incident in the establishment's illness/complaint register | ☐ | |
5.9 | Retain all documentation for a minimum of 5 years (or as required by law) | ☐ |
SECTION 6 — CORRECTIVE ACTIONS
# | Checklist Item | ✔ | Notes |
6.1 | Immediately remove suspected food products from service | ☐ | |
6.2 | Quarantine and label all suspect ingredients or batches | ☐ | |
6.3 | Conduct deep cleaning and sanitisation of implicated areas and equipment | ☐ | |
6.4 | Conduct refresher training with all relevant staff | ☐ | |
6.5 | Review and update food safety procedures and SOPs as necessary | ☐ | |
6.6 | Follow up with the affected guest professionally and empathetically | ☐ | |
6.7 | Confirm the guest is recovering and provide any required support | ☐ | |
6.8 | Document all findings, decisions, and corrective actions taken | ☐ | |
6.9 | Schedule a follow-up internal review within 7 days to confirm actions are in place. | ☐ |
INVESTIGATION OUTCOME SUMMARY
Item | Details |
Investigation Conducted By | |
Position / Title | |
Date Investigation Commenced | |
Date Investigation Completed | |
Suspected Cause of Illness | |
Findings Summary | |
Corrective Actions Taken | |
Reported to Health Authorities? | ☐ Yes ☐ No — If yes, date: |
Guest Follow-Up Completed? | ☐ Yes ☐ No |
Further Review Required? | ☐ Yes ☐ No — If yes, date: |
Manager Signature | |
General Manager / Owner Sign-Off |
This checklist must be completed as soon as possible following receipt of a guest illness complaint. All records must be kept confidential and retained in accordance with applicable food safety legislation.