中文版本


Catering Services Food Borne Illness Reporting Form

Basic information

* - Mandatory



Suffering from Illness

Symptoms

( time(s) in 24 hrs) (Highest Temp ℃)
( time(s) in 24 hrs)

Place Food was supplied

Main Campus

























Other Campuses






Hall Catering Services



Food Items Consumed and Details:
1. consumed on (date) at (time)
2. consumed on (date) at (time)
3. consumed on (date) at (time)
4. consumed on (date) at (time)
How Long had the Food Been Kept Before Consumption:
Was Medical Care Sought?

Name of other Persons in the Party With or Without Symptoms (if any)

1. Tel:
2. Tel:
3. Tel:
4. Tel:
5. Tel:
6. Tel:

If you would like to provide more information or need further assistance, please contact Sam Poon, Catering Manager at 2859 2285 or swhpoon@hku.hk