Food & Lodging Program Sanitation Complaint Form

Food Safety and Lodging Sanitation Complaint

Thank you for contacting the Vermont Department of Health regarding a concern about food safety or sanitation in a food or lodging establishment serving the public. Providing detailed information regarding your complaint will allow the department to evaluate the information for follow-up. Please be as detailed as possible to provide a complete picture of your concerns and observations. For example, a complaint that is one sentence long with limited information does not provide enough information for follow-up.

Please know that we understand your desire for privacy however we often have questions about the complaints we investigate. If we are unable to contact you, it could slow or stop our investigation.

1. Your Contact Information *This question is required.

First Name

Last Name

City

State

Email Address

Phone Number

Food Safety and Lodging Complaint

Required fields are marked by an asterisk (*).

2. Date Occurred: *This question is required. This question requires a valid date format of MM/DD/YYYY.

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3. Time Occurred:

4. Is this complaint about a lodging establishment? *This question is required.

5. Room Number(s)/Location:

5. Name of Establishment *This question is required.

6. The location, street address, or nearest town associated with this complaint: *This question is required.

7. Are you a current or former employee at this establishment or working with this event?

8. Description of complaint: *This question is required.