Have you had any sickness in the last 7 days? (If yes, please give details)
Have you been overseas in the last 12 months? (If yes, please state where)
List all foods consumed during dining (including any alcohol):
List symptoms of alleged illness:
State the incubation period (length of time till the onset of symptoms of alleged illness):
Duration of alleged illness:
Have you visited a doctor?
If yes, was a stool sample provided?
(Part of the investigation into any allegation requires a stool test to be undertaken)
List all foods consumed over the past 72 hours (split foods into meals including breakfast, lunch, dinner and snack)