Centralized Foodborne Illness Complaint System

Background

Foodborne illness complaints are reports people make to health departments about suspected foodborne illness. These complaints help health departments identify foodborne illness outbreaks more quickly.

Compared to healthcare reporting, using complaint systems to identify outbreaks can considerably shorten the time between when someone is exposed to a pathogen and when public health authorities get notified. By quickly detecting possible outbreaks, public health staff can take action to reduce disease transmission and recurrence.

Key actions

The Tennessee Department of Health developed a centralized foodborne illness complaint system for state residents. Users could reside in any jurisdiction. Their program involves three components.

• Building a centralized database to collect information about complaints from the public. The health department used REDCap. See example data dictionary below.
• Training foodborne illness complaint staff. This includes navigating the database and shadowing a foodborne illness expert.
• Monitoring complaints through four steps:
  • Review complaints to extract key details
  • Cross-reference complaint details, such as food establishment, to identify possible outbreaks
  • Prioritize complaints based on public health risksto determine next steps or response(see example standard operating procedures below)
  • Notify the local health department if additional investigation is necessary

Using this practice

We selected this practice as an example of environmental public health successfully applied in the field. We based our selection on four domains:

• Effectiveness: Did it solve or help solve the environmental health problem?
• Feasibility: What conditions and resources are needed to use it?
• Sustainability: Is it realistically able to continue going forward?
• Transferability: Could other health departments use it with little to no changes?

Others interested in applying this practice can consider these factors and this health department's experience.

Effectiveness

The complaint system helped the health department more rapidly escalate complaints to identify outbreaks. The centralized system can notify the relevant local health department of a high-priority complaint within minutes.

The program also noted the following improvements:

• The new system prioritizes notifying stakeholders for complaints most likely to be related to an outbreak. This saved approximately 1,000 hours of staff time per year by reducing administrative burden and limiting investigations. Investigations were focused on complaints with enough accurate information to determine if an outbreak was occurring.
• The standardized processes across regional, local, and metropolitan health departments reduced the time and resources needed to investigate complaints.
• The REDCap survey enabled staff to develop reports, track outcomes, and describe the public health burden of responding to foodborne illness complaints.

Feasibility

Based on Tennessee's experience, other health departments interested in this practice may want to consider the following factors:

• Cost: Other than staff time, the costs for this practice are minimal. The health department used the REDCap platform. The system required 1–2 full-time employees with a three-person team on a rotation. On average, 2 to 4 complaints were received per day.
• Attitude and culture: Support from leadership and staff from state and local environmental health and epidemiology programs are critical. The health department had support from the enteric disease program director, environmental health director, and state epidemiologist. Leadership was supportive, engaged in the development process, and championed implementation during statewide meetings and email communications.
• Regulation or policy: Complaint system protocols should follow state or local health department policy for responding to foodborne illness complaints.
• Workforce and training: The complaint system requires staff with subject matter expertise in foodborne disease, environmental health, and epidemiology. Depending on prior knowledge, additional training can take approximately 1–3 weeks.

Sustainability

The health department launched its centralized complaint system in 2017 and has sustained it since. Managing a complaint system requires designated, specially trained staff. However, the three staff assigned to the system were able to manage other job responsibilities.

Program funds incorporated into the health department's budget allow the practice to be sustained. The complaint system was also supported by external funding. In addition, the environmental health program supports the system with funds generated through permitting.

Transferability

Programs interested in this practice might want to consider the level of interest and support they have from state or local leaders to establish a centralized public-facing complaint system.

Consulting with state partners and existing guidelines can be helpful, particularly the Guidelines for Foodborne Illness Complaint Systems from the Council to Improve Foodborne Outbreak Response. Health departments can build a complaint database from scratch or adapt one from existing data collection instruments.

Successes and challenges

• Obtaining consensus across the state was the largest barrier. Establishing and leveraging partnerships, especially among leaders of related programs (like epidemiology and laboratory programs) helped improve uptake and acceptance of the system.
• The complaint system and related resources can help food safety programs, whether or not they already have a foodborne illness complaint system.

Connections to Essential Services

Documenting how programs contribute to the Essential Public Health Services may help health departments in the accreditation process with the Public Health Accreditation Board. The activities in this practice support and align with several services:

• Assess and monitor (1)
• Investigate and address hazards (2)
• Educate (3)
• Strengthen communities and partnerships (4)
• Utilize legal/regulatory actions (6)
• Improve or innovate (9)

Resources

Tennessee Department of Health

• Complaint system management standard operating procedure
• Complaint triage algorithm
• Foodborne illness complaint form
• Public complaint data dictionary (CSV file, can be imported to a new project in REDCap to create or adapt the complaint form)

CDC and partners

• Complaint systems (Council to Improve Foodborne Outbreak Response, CIFOR)
• Guidelines for foodborne disease outbreak response (CIFOR)
• Standard 5 - Foodborne illness and food defense preparedness and response (Food and Drug Administration's Voluntary National Retail Food Regulatory Program Standards)
• Using foodborne illness complaint systems as an effective tool for surveillance (CDC)

Citation

In citing this practice in articles, presentations, or elsewhere, we suggest the following citation:

Centers for Disease Control and Prevention. National Center for Environmental Health. Environmental Public Health Practices Gateway. Centralized foodborne illness complaint system: A practice from the Tennessee Department of Health. U.S. Department of Health and Human Services, CDC, 2026, https://www.cdc.gov/environmental-health-practice/php/gateway/centralized-foodborne-illness-complaint-system.html.