Bio-Science Technologies (Pty) Ltd

ISO / IEC 17025 Accredited Independent Testing Laboratories

Established 2003

In association with ISO/IEC 17025 accredited Chem-Science Laboratories cc

Food Technologists and Microbiologists, Hygiene Auditors and HACCP Consultants

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Please complete online and submit to us; or email, or print out and fax to us:

Also please attach any relevant documents, such as a Doctor's diagnosis or prognosis.

Food Poisoning Information Form

Company name:

Name of contact person:

Email address:

Type or class of food product:
e.g. prawns

Any defects noted in samples submitted?:
e.g. damaged packaging

Expiry date or Best Before date:
e.g. 12 2014

Batch numbers or any identifiable markings on original packaging: e.g. 1334:a mch

What poisoning symptoms were experienced?:
e.g. nausea

How long after consuming or coming into contact with the food did symptoms occur?:
e.g. 3 hours after consumption

Were other foodstuff/beverages consumed at the same time as the suspected poisoning?:
e.g. colesaw salad

How long did symptoms last after they first appeared?:
e.g. overnight

How was the food stored before consumption?:
e.g. re-warmed in microwave oven

What are the recommended storage temperatures listed on the product package?:
e.g. refrigerate

What are the reheating or cooking instructions listed on the product package?:
e.g. boil for 5 minutes

Have any factory or restuarant recipe or processing changes been made prior to the complaint?:
e.g. preservative added

Have any other similar complaints been received?:
e.g. same batch, same shop, whole family

I acknowledge that the above information is correct: Signature

Date:

NOTE: All information supplied to Bio-Science Technologies (Pty) Ltd is treated as strictly confidential.

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