Food Standards Scotland
Food Incident Report Form

Local Authorities should use the form below to report a food incident to FSS. Upon completion of the form, you will receive a confirmation email with details of what you have submitted and a copy of the incident report form for your records.
Alternatively, the form can be downloaded and e-mailed to incidents@fss.scot.
Download a copy of the incident report form
                            
                                    Food Incident Report Form
                                
                                        1. Name and Address of Reporting Food Authority
                                    
                                        2. Name of Reporting Officer
                                    
                                        2.1 Telephone Number of Reporting Officer
                                    
                                        2.2 Email Address of Reporting Officer
                                    
                                        3. Date & Time Initial Information Received by Reporting Food Authority
                                    
                                        4. Initial Information received from (eg. Local Food Authority, HPS, etc - include name, address, contact details)
                                    
                                        5. Method Information Received (eg. telephone / fax / letter / other):
                                    
                                        6. Brief Description of Incident
                                    
                                        7. Contamination Type (e.g. microbiological / chemical / physical – if physical please advise type of injury this may cause)
                                    
                                        8. Breach in Legislation? (Include legislation, maximum permitted levels etc)
                                    
                                        9. What Stage has the Incident likely to have occurred
                                    
                                        10. Product Description
                                        
                                        a. Type of Product
                                    
                                        b. Product Name
                                    
                                        c. Product Brand Name
                                    
                                        d. Batch Code/s
                                    
                                        e. Description of Packaging
                                    
                                        f. Pack Size
                                    
                                        g. Durability Date/s or Code/s
                                    
                                        h. Country of Origin
                                    
                                        i. UK Importer / Distributor (including contact details)
                                    
                                        j. Product Manufacturer (including contact details)
                                    
                                        11. Details of Distribution (including when product / batch was placed on market, quantities involved, areas, export to EU & third countries):
                                    
                                        12. Has Clinical Illness Occurred? Please provide details (eg. symptoms, type of illness, number of consumers affected, samples submitted, etc 
                                    
                                        13. How is the company (manufacturer / retailer / supplier) dealing with the incident and what steps / next steps are to be taken?
                                    
                                        14. Assessment of Hazard (please tick as many as appropriate):
                                    
  Local
  Regional
  National
  International
  Manufacture
  Retail
  Catering
  Import / Export

                                        15. Enforcement Action, if applicable (eg what samples have been taken / what notices have been served / has food been seized / etc – all lab reports)
                                    
                                        16. Is Malicious or Fraudulent Activity Suspected?
                                    
                                        17. Has there been Media Interest?
                                    
Yes

No

                                        17.1 If Yes, Please Upload a Press Release. (.pdf, .doc, .jpg)
                                    
                                        18. Additional Information
                                    
                                        Name
                                    
                                        Date (dd/mm/yyyy)
                                    
                                        Job Title
                                    
                                        Please enter the word you see in the image below: