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2. Have a concern regarding a food establishment?

   Please complete the form below describing your complaint. If the health inspector has any questions regarding your complaint you may be contacted. If you have further questions or concerns please call 309.524.2373.

4. Complainant Name:
5. Complainant Phone Number:
7. Food Establishment Name:*
9. Complaint Type:*
   -- Select One --Foodborne IllnessUnsanitary ConditionsEmployee Hygiene
11. If the complaint is regarding a Foodborne Illness: Describe all food items ordered (including toppings, sides, drinks, etc.)., and symptom onset time.
13. Describe the Issue:*
15. Was the Food Business Contacted?*
    -- Select One --YesNo
17. Date and Time the Complaint Occurred:*
    Date and Time the Complaint Occurred:

    Date and Time the Complaint Occurred:
Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field