Food Illness Report Page

If you believe that you became sick from eating or drinking something, please file a report by filling out the form below. Although only the information in the highlighted fields marked with an asterisk, is required, filling out all of the questions will aid in your complaint being responded to in a shorter timeframe. All reports received after hours or on the weekend will be responded to on the following business day. Please use this form to report food establishments in Los Angeles County ONLY.

To report a food establishment in Pasadena, please contact: Pasadena

To report a food establishment in Long beach, please contact: Long Beach

Other local Health Departments: http://www.publichealth.lacounty.gov/acd/Cdrs2.htm

Contact Information

* First Name * Last Name * Daytime Phone Number
Evening Phone Number Email Address
Address Information
Number Street Name Apt # City State Zip Code
How many people in your party ate the suspected food?   Number ill?
* Did you become ill?  
  Are you still ill?   

Additional Contact Information


First Name Last Name Daytime Phone # Evening Phone #

Describe the Food Eaten

Was the food purchased or prepared at a commercial food establishment?
Was the food eaten at the establishment?

Food Source Location Information


* Name of Establishment Cross Streets Near Establishment
Address Information
Number * Street Name * City State Zip Code
Food Eaten (one food per line)
* Date Eaten (MM/DD/YYYY)  Time Eaten AM/PM

Describe the Illness

Duration of Illness
Onset Date of Illness Onset Time of Illness AM/PM Days Hours
Symptoms (check all that apply) Other Symptoms



Did any ill individuals seek medical care?

Medical Services Sought


Care Type Facility Name
Additional Information

Please only click the Submit button once, or you may duplicate your report. A confirmation number will appear once your report is processed.