Example template for notifying the enforcement authority

Food Incident Report Form for FBOs notifying enforcement authorities

(notifications to FSA/FSS should be made using online form)

Food business name and address:

Food business operator (FBO) details:

Name of FBO
Contact details (business hours)	Telephone: Email: Fax:
Contact details (out-with business hours)	Telephone: Email:

Description of food safety incident:

Description of product:

Type of Product:

Product Name:

Brand Name:

Batch Code(s)/Durability date(s):

Product Size and type of packaging:

Country of Origin of food:

Distribution details:

Manufacturer details (including contact details):

Import/Export details (including contact details):

List of business customers supplied to:

Quantities, batch codes and pack sizes sent to each customer:

When food first placed on the market and has food reached consumer:

Details of risk assessment (if applicable) and action (including justification) for dealing with incident:

Any additional information: