Customer Occurrence Report

Customer Occurrence Reports

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Foreign Object
Report Date: Reported by (name and position): National Restaurant Number: Restaurant Name:
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Customer Information
Note: If the customer is a minor, please provide the guardian information in the "describe the incident in more detail" section of this form.
Title: First Name: Last Name:
Street and Number: Municipality (City, Town, etc.): Province/State:
Postal Code: Country: E-Mail Address:
Day Phone number (Please include Area Code): Evening Phone number (Please include Area Code): Cell or Other Phone number (Please include Area Code):
Foreign Object - Product Information
Date and Time of Incident: Menu Item Involved (e.g. Big Mac):
/ /
:
Raw Item(s) Involved (e.g. Lettuce): use before date:
Raw Item(s) Involved (e.g. Lettuce): use before date:
Raw Item(s) Involved (e.g. Lettuce): use before date:
Raw Item(s) Involved (e.g. Lettuce): use before date:
Is Object Attached? If NO, who has object?
Yes No
Is Object restaurant related? Describe Object:
Yes No Unknown
Where was the object found (e.g. embedded in product):
Was customer injured? If Yes, provide details below:
Yes No
Is surveillance available for this incident?
Yes No
All Video must be copied. If this is not possible, please provide a reason why it cannot be copied:
Follow-up (Must Complete)
Does Customer require follow-up? If YES, who will perform the follow-up?
Yes No Owner Manager Consultant Insurance Adjuster Other
If Other, please specify:
Did the customer discuss or request compensation? If Yes, did you advise customer that compensation request must be investigated by our insurers, who will be the next point of contact:
Yes No Yes No
Did the customer threaten legal action? If Yes, did you provide customer with appropriate information (company and contact name, address, etc.)?
Yes No Yes No
Please describe the incident in greater detail:

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