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Complaints

(In Allen County, Indiana Only)

 

Complaint Type:
Establishment Name:
Establishment Address:
Date Complaint Observed:
Time Complaint Observed:
If Hotel/Motel Complaint,  
Location of Complaint (ie. Room Number):
Complaint Observed:
Did you contact management?
If so, list the name of the person you contacted?
If Food Complaint,  
Nature of the Complaint:
For multiple choices, select 1st choice, then holding CTRL button down, select 2nd choice.
If complaint is of illness, be sure to submit name and daytime phone number.  A department representative will contact you for more information.  Please do not submit any medical information.
List the Complaint:
Was the food or beverage consumed in the
establishment or carried out?
What exact food item(s) involved?
Complainant's Name (Optional):
Complainant's Daytime Phone Number (Optional):
Complainant's Address (Optional):

 

 

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This page last updated:  January 09, 2008

 

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