FOR-3.2.3a Description of Complaint

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

Source Of Complaint

•  Customer  Consumer  Regulatory agency - Please specify

• Name and address of Branch involved

Complainant Details:

• Customer Name

• Complainant address:

• Complainant Contact Number:

• Complainant Email address:

• Sex (Female/Male)

• Food Consumed

  Yes

  No

  N/A

• Date and Time Consumed

Type of Complaint

•  Product quality  Illness  Allergen  Foreign body - Please specify

Product Details

• Product Name

• Batch Code:

• Production Date:

• Best Before/Used By Date:

• Delivery Date

• Quantity Purchased

Complaint details

• Brief details:

• Photo evidence

  Media

• Have they suffer any injury?

  Yes

  No

  N/A

• Do they have any medical evidence?

  Yes

  No

  N/A

• Do they haven receipt of any expenses incurred?

  Yes

  No

  N/A

• Have they reported the complaint to any third party e.g. Individual or government organisation?

  Yes

  No

  N/A

Root Cause

• Brief Details:

Response to complainant

• Brief Details

• Is product Withdrawal /Recall required?

  Yes

  No

  N/A

• Corrective action required?

  Yes

  No

  N/A

Action to be taken

• Brief details of action

Complaint closed off

• Completed by

• Date completed

  Date

• Signed

  Sign