Form 1: Customer Complaint Form: Foreign Body Complaint

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

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• Customer name

• Address
  Address

• Ref no

• Sex

  M

  F

• Approx. age of customer

• Telephone no

• Email address

• Name & address of others in party

• Food consumed

• Date and time consumed

  Date

• Batch code information

• Use-by/best before date

  Date

• Details of foreign object

• Have they reported the complaint to anyone else e.g. EHO?

  Yes

  No

• Who? Name and address

• Have they suffered any injury?

  Yes

  No

• Please provide details

• Do they have medical evidence?

  Yes

  No

• Do they have receipt of any expenses incurred?

  Yes

  No

• Report completed by: (Name and Signature)

  Sign

• Referred to