Food Safety and Lodging Complaint

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If you choose to remain anonymous, please know that we understand your desire for privacy and you may skip the "Your Contact Information" section below. Any contact information you provide would be subject to release if a request was made under the Kansas Open Records Act. However, we sometimes have questions about the complaints we investigate. If we are unable to contact you, it could slow or stop our investigation.

If you want to leave your contact information, please complete the "Your Contact Information" section below so that we may reach you if we need additional information. Any contact information you provide would be subject to release if a request was made under the Kansas Open Records Act.

Your Contact Information

First Name:

Last Name:

Street Address:

City:

State:

Zip:

Email Address:

Telephone:

Format example: (913) 555-1212

Food Safety and Lodging Complaint

Required fields are marked by an asterisk (*).

* Date Occurred:

Format example: 12/12/2012

Time Occurred:

Room Number(s)/Location:

* Name of establishment:

* The location, street address, nearest city or county associated with this complaint:

The incident I am reporting resulted in illness or other adverse health effects to humans, animals or plants.

NoYes

* Description of complaint:

Information provided may be subject to disclosure under the Kansas Open Records Act K.S.A. 45-215 et seq.

Important Note: Please understand that this form submits the information to our database and emails the Food Safety and Lodging Program with your complaint. It will take the system just a minute to complete the submission - Please Click the Submit Button only once.

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Kansas Department of Agriculture

Food Safety and Lodging Complaint

Your Contact Information

Food Safety and Lodging Complaint