FOOD BORNE ILLNESS QUESTIONNAIRETo be filled in cases of suspected Food Borne Illness / Food Poisoning claims.
Blood in stool
Household memberskindly fill in the below details for all people living in the same house:
Have you been in the company of others suffering from diarrhoea/ similar symptom?
Did you travel abroad?
Did you visit an animal / bird farm ?
Did you partake in any water activity like swimming, jaccuzzi?
Did you attend any social events like parties, receptions, trainings, restaurant ?
Did you drink any untreated water / tap water ?
Please fill in the food history as much as possible, to identify a possible source of infection