201 W. Kenyon Rd. Champaign, IL 61820 map - 217-352-7961 - 24 hours every day HomeContact UsFAQA-Z IndexSearch
CHAMPAIGN URBANA PUBLIC HEALTH DISTRICT
Our mission:
To improve the health, safety and
well-being of the community through prevention, education, collaboration,
and regulation.
About CUPHD
Maternal and Child Health Dental Health Environmental Health Infectious Disease Prevention & Mgmt. Wellness and Health Promotion

Submit A Food Service Complaint

NOTE: If you believe that you or a family member became sick after eating at a local food service establishments please fill out our foodborne illnesses form instead.

Your name:
Your address:
City:
State:
Your phone number: ex 217-000-0000
Your email address:
Do we have your permission to release your name, etc. to the food service? Yes No
Would you like a follow-up call from the inspector? Yes No
Date Incident Occurred: Select a different date ex 04-05-2006
Time Incident occurred:  a.m. p.m.
Name of Food Service:
Address of Food Service:
City:

Description of Complaint:

Did you discuss this matter with anyone at the Food Service? Yes No
If yes, with whom: