Partnerships for a Foodborne Illness Complaint System

Background

Foodborne illness complaints are reports people make to health departments about suspected foodborne illness. Foodborne illness complaint systems are critical tools for detecting and responding to outbreaks.

The Food and Drug Administration’s Voluntary National Retail Food Regulatory Program Standards (Standard 5) require food safety programs to maintain a system to detect and respond to food-related illness complaints. Weaknesses in complaint intake, data management, and cross-agency communication can delay outbreak detection and reduce the effectiveness of outbreak response.

Key actions

The Minnesota Department of Health aimed to strengthen and formalize its complaint system to improve early outbreak detection, reduce foodborne illness, and ensure environmental health resources are directed at addressing the most likely sources of illness.

They focused on standardizing complaint intake, centralizing review, integrating with laboratory-based surveillance, and improving referral times to regulatory partners. They coordinated with many programs and jurisdictions to clarify roles, referral pathways, and communication procedures. Their complaint system has the following main components:

• Receiving complaints from the public through phone, online forms, and email to improve accessibility and reporting
• Interviewing people who submitted a complaint using standardized questions about their symptoms
• Entering complaint and laboratory exposure data into a centralized database (REDCap) to support consistent tracking and analysis
• Assigning a single reviewer to monitor incoming reports
• Reviewing complaints for patterns indicating a potential outbreak
  • Identifying clusters of complaints linked to one facility
  • Assessing complaint clusters to see if multiple people had a similar illness with similar incubation periods
  • Comparing complaint data with laboratory-confirmed cases identified through reportable disease surveillance
• Referring complaints to responsible jurisdictions, as needed

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?

Effectiveness

A strong foodborne illness complaint system can help health departments detect outbreaks faster and send investigators where they need to go. Ultimately, a strong system can result in fewer foodborne illnesses.

The health department measured effectiveness by tracking the number of outbreaks detected from complaints, the time from complaint to action, the percentage of complaints with complete key fields, and how often complaints were linked to laboratory-confirmed cases identified by reportable disease surveillance. They documented these findings:

• Adding an online complaint form identified outbreaks that were not being reported via phone.
• Offering online complaint reporting increased the number of outbreaks detected.
• Initially, online reporting made up only 20% of complaints, but it is now the most popular way to report them.

Internal reviews and peer-reviewed evaluations helped document the effectiveness of this practice.

Feasibility

Other health departments interested in this practice may need the following capacity:

• Dedicated staff time for complaint intake and review (often ~0.1–1.0 FTE depending on complaint volume)
• A single, consistent reviewer to improve pattern detection
• One reporting database (REDCap or another platform) to manage complaint data and laboratory-based surveillance results
• An online reporting option (may require minimal to modest information technology support)
• Standard interview questions and triage steps (based on CIFOR guidance)
• Partner engagement and clear handoff procedures between epidemiology and environmental health and between regulatory jurisdictions
• Staff with basic training in common foodborne illness symptoms and incubation periods, interviewing, and food history collection (Food Safety Centers of Excellence can serve as a resource)

The health department and its partners supported the complaint system through local and state funding.

Sustainability

Health departments can help sustain this practice through the following actions:

• Ensuring stable funding for a complaint system reviewer (the biggest long-term need)
• Integrating the practice into routine work for epidemiology and environmental health programs
• Evaluating how the system is finding outbreaks and improving response
• Maintaining partnerships for referrals and coordinated follow-up across jurisdictions
• Updating software and online forms
• Conducting data quality checks regularly, especially for online complaints

The health department has successfully sustained their system since 1998, including during COVID-related staffing disruptions.

Transferability

Programs interested in this practice might want to consider the following factors:

• Local program structure: Who leads intake, triage, and follow-up activities (the environmental health program, epidemiology program, or both)?
• Referral pathways: How are complaints routed to the correct regulatory jurisdiction?
• System: What database (REDCap or other) supports standardized data entry and reporting?
• Staffing model: Is there one consistent reviewer (to improve detection of a possible outbreak)?
• Minimum viable approach: What parts of the system can be implemented first, then expanded?

This practice is generally transferable to most jurisdictions. The main limitations are staffing time and coordination across teams or agencies.

Successes and challenges

Successes

• Demonstrated effectiveness through internal reviews and peer reviews
• Accelerated identification of clusters by routing complaints through one reviewer
• Improved outbreak detection by integrating complaints with laboratory surveillance data
• Increased efficiency of environmental health resources by focusing on most likely exposure sources
• Maintained system sustainability and resiliency (has been operating successfully for decades, even during COVID)
• Reduced the time staff spent answering phone calls
• Improved access for the public by using online forms
• Improved service to the public by having a single place to report illness complaints from anywhere in the state

Challenges

• Staffing needs vary widely; higher complaint volume may require additional staff
• Practice requires strong coordination and communication between staff across epidemiology, environmental health, public health laboratories, and partner jurisdictions
• Online complaints still need data quality checks to avoid missing key details
• Culture change may be needed to consistently collect complete food histories and factor in how long it takes symptoms to appear

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)
• Utilize legal and regulatory actions (6)
• Support the workforce (8)
• Improve or innovate (9)
• Build public health infrastructure (10)

Resources

Minnesota Department of Health

• Complaint systems
• Evaluation of a statewide foodborne illness complaint surveillance system in Minnesota, 2000 through 2006 (journal article)
• Use of online consumer complaint forms to enhance complaint-based surveillance for foodborne illness outbreaks in Minnesota (journal article)

Council to Improve Foodborne Outbreak Response

• Complaint systems (tools, etc.)
• Guidelines for foodborne illness complaint systems (templates, metrics information, guidelines for multiple agency structures, etc.)

CDC and partners

• Integrated Food Safety Centers of Excellence
• Products (field-tested tools, curriculum, training packages, and more from the Integrated Food Safety Centers of Excellence)
• Training and resources (practical tools for identifying root causes of outbreaks)

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. Partnerships for a foodborne illness complaint system: A practice from the Minnesota Department of Health. U.S. Department of Health and Human Services, CDC, 2026, https://www.cdc.gov/environmental-health-practice/php/gateway/partnerships-for-a-foodborne-illness-complaint-system.html.