Food Adulteration Cell

Reporter Information

Identity Preference

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Full Name *

Email Address *

Phone Number *

Relationship to Issue

Address

Food Product Details

Product Name *

Brand/Manufacturer

Product Category

Batch/Lot Number

Expiry Date

Manufacturing Date

Date of Purchase *

Place of Purchase *

Purchase Price

Packaging Details

Issue Details

Type of Issue *

Severity Level

Date of Discovery *

Was Product Consumed?

Detailed Description *

Health effects experienced

Affected Persons

Number of People Affected

Multiple people were affected

Children are among the affectedElderly persons are among the affectedPregnant women are among the affected

Witnesses

There were witnesses to this incident

Evidence

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Description of Evidence

Storage Conditions

Vendor/Shop Information

Vendor Name

Vendor Contact

Vendor Address

License Details

Vendor's Response

Previous Actions

This issue has been reported before

Vendor has been contactedFSSAI contactedConsumer forum approachedHealth department informed

Other Actions Taken

Additional Information

Similar Incidents?

Potential Community Impact

Suggested Preventive Measures

Any Other Relevant Info

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