Product Incident Report.pdf

This document is an Incident Report Form designed to record alleged food harm incidents related to food consumption injuries. The form is associated with "IFD" (likely a food distribution or inspection entity), though no specific states, agencies, or jurisdictions are explicitly identified in the document header or content areas.

The form is structured to capture comprehensive incident details including reporter information, incident timing and location, customer information, and product identification data. Key data fields include incident date/time, customer location (city, state, zip code), involved parties, incident description, and product information such as IFD item numbers, product descriptions, brand names, and lot numbers. The form includes a section for follow-up actions to be completed by IFD personnel. This appears to be an internal operational form rather than a contract vehicle, designed for documenting and tracking food safety incidents within a food service or distribution system.