Unlicensed Food Sales Report Form
Use this form to report suspected unlicensed food sales and provide details that can help review the incident.
Reporter Information
Reporter Name
First Name
Middle Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Method
*
Email
Phone
Incident Details
Date of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Incident
*
Hour Minutes
AM
PM
AM/PM Option
Incident Location / Address
*
Description of What Happened
*
Type of Report
Please Select
Street Vendor
Home-Based Food Sale
Mobile Cart
Pop-Up Stand
Other
Seller and Activity Information
Seller Name or Business Name
Apparent License Status
*
Please Select
Licensed
Unlicensed
Unknown
Food Items Being Sold
*
Sale Location Type
*
Vehicle
Cart
Stand
Home
Premises
Other
Vehicle, Cart, or Stand Description
Frequency of Occurrence
Please Select
One-time
Daily
Weekly
Occasional
Identifying Details
Evidence and Follow-up
Evidence Files
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Additional Comments or Witness Notes
Willing to Be Contacted for Follow-up
Yes
No
Submit Report
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