Food Establishment Complaint

2. Food Establishment Complaint Form

   Complete the form if you witnessed unsanitary conditions or believe there is an issue that requires investigation. All complaints are investigated and kept confidential. If you became sick after eating at a food establishment, please call 610-344-6452 instead of submitting this form.

   Complete the form if you witnessed unsanitary conditions or believe there is an issue that requires investigation. All complaints are investigated and kept confidential. If you became sick after eating at a food establishment, please call 610-344-6452 instead of submitting this form.

4. Consumer Information

6. Date of Incident*

8. Name*

9. Phone*

11. Address1

12. Email*

14. City

15. State

16. Zip

20. Facility Information

22. Name of Establishment*

24. Address

25. City*

27. Food Purchased

28. Was food packaged?
    -- Select One --YesNo

30. Complaint Details*

Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field