Investigation Summary

• Store Name / Number

• Store Name / Number (please include again)

• Reason for Investigation

  Select Severity 1 Customer Complaint Regulator Contact Internal Incident

  • Severity 1 Customer Complaint
  • Regulator Contact
  • Internal Incident

• CRM Number

• Date of Complaint

• Authority Name.

• Date of Contact.

• Date of Investigation

• Investigated By

Incident Summary. Include all details as specified. Include any available photos to assist illustrating the issue.

• Reason for Investigation.

  Select Severity 1 Customer Complaint Regulator Contact Internal Incident

  • Severity 1 Customer Complaint
  • Regulator Contact
  • Internal Incident

• Complaint Type

  Select Product Related Illness Product Contamination (metal) Product Contamination (glass) Product Contamination (Plastic) Product Contamination (chemical) Product Contamination (other) Out of Date Product (Causing Illness) Out of Date Product (No Illness) Allergic Reaction Product Tampering Other

  • Product Related Illness
  • Product Contamination (metal)
  • Product Contamination (glass)
  • Product Contamination (Plastic)
  • Product Contamination (chemical)
  • Product Contamination (other)
  • Out of Date Product (Causing Illness)
  • Out of Date Product (No Illness)
  • Allergic Reaction
  • Product Tampering
  • Other

• Further Details if "Other"

• Product Description

• Reference Number

• Supplier.

• Batch Details.

• Details of Complaint

• Authority.

• Inspector Name.

• Contact Details.

• Reason for contact.

• Details of Incident

• Photos

  Media

Investigation Summary. Please provide details of all phone calls and store visits carried out as part of the investigation, including dates. Please add any photos to assist demonstrating root cause or any control breakdowns identified.

• Details of Investigation.

• Was root cause identified.

  Select Yes No

  • Yes
  • No

• Details of root cause.

• We're any other control breakdowns identified.

  Select Yes No

  • Yes
  • No

• Details of control breakdowns.

• Photos

  Media

Action Taken.

• Immediate Action Taken.

• Longer Term Recommendations / Solutions.

• Copy of report provided to (Name & Title).

• Photos

  Media

Sign Off

• Food Safety Specialist

  Sign