Intake

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How are you filing this report?

Online

Phone Call

Pilot

Date of Incident

If there is no specific incident date, please enter today's date

Incident Description

Please do not use employee names in the incident description (ex: Employee fell on wet floor and sustained elbow injury).

Please be as detailed as possible to help facilitate an efficient investigation

Please select the reason for this report

Hotline Issue

Global Security

Workplace Injury

Food Safety Incident

Below is the definition of the incident type selected

Food Safety Incident- Includes alleged food-related illness, allergic reaction, and foreign object inclusion / quality issue.

Hotline Issue - Raise a concern of a possible violation of the Aramark Business Conduct Policy or any law.

Global Security - If you are a manager, this form is used to report and/or document a security incident to the Global Security team.

Workplace Injury - Accident/illness that occurs at work or during work hours

Other

Environmental Issue - Issue or incident involving the release or spill of chemicals, fuel, oils, refrigerant, or grease into the air, land, water, or storm drains.

OR

Marine Claim - Accident occurring on the water

Auto Accident - Incident involving an Aramark owned or leased vehicle

Property Damage - Property damage to any owned or leased Aramark building or property

Please give a one or two line summary of what happened?

Reporter & Contact Person

Reported by

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Reporter Profit Center

Reporter Email Address

Reporter Phone Number

Reporter state hidden

Reported by ID Hidden

Is the reporting person also the primary contact?

Yes

Contact Person

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Contact Person Profit Center

Contact Person Email Address

Contact Person Phone Number

Contact Person ID Hidden

Contact Person state hidden

Notification Date to Business

Profit Center Info

Name of profit center where incident took place

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PC State Hidden

Country Hidden

LOB Hidden - for popup only

Food Safety

General Details

GL Hidden Coverage Major

GL Hidden Record Type

8 - Hidden Owner

Food Related Incident

Time of Incident

Use 24 hour clock

Were you the manager on duty at time of incident

Yes

Manager on Duty at time of Incident

Claimant First Name

Claimant Last Name

Is there a regulatory agency involved (e.g. Health Department)?

Yes

Unknown

What is the name of the agency and who is the point of contact

Have incident details been posted to social media (Facebook, TikTok, Instagram, etc) or otherwise reported publicly (Newspaper)?

Yes

Unknown

What station or outlet was the food in question served from?

Please provide details

Incident Details:

	Potential Foodborne Illness	Foreign Object	Allergic Reaction	Other
Select Incident Type

Product

Instructions

This form should be submitted in the event of:

1. A product food safety incident such as spoilage, mold, off-flavor, or discoloration.

2. A foreign object/defect in a product such as wood, metal, plastic, or increased insect/worm activity in produce. It is critical that incidents are reported as soon as possible after the occurrence so the appropriate parties can take action to achieve satisfactory resolution.

What to expect: Once this intake form is submitted, it will be routed to your Director of Distribution who will then share with the relevant parties for a formal investigation. Once the investigation is complete to the satisfaction of Supply Chain, you will receive communication regarding the resolution and corrective actions taken.

Region Map of Directors of Distribution

Important Information:

It is important to provide accurate information and as much detail as possible to ensure a thorough investigation.
Lot code information is critical to enable traceability of the batch (where and when the product was produced) and to ensure proper credits. Lot Code Guidance; If lot code is not available, a QA investigation cannot proceed completely. Reach out to your distributor/supplier contact to request a credit or replacement. Your Director of Distribution will support with escalation as necessary.
Place affected product on hold and retain cases/packaging. • Attach photos, invoice copies, and any other supporting documentation associated with this incident, as necessary
Fields with an asterisk are required. If you do not have the required information, contact your Director of Distribution for guidance.

Supply Chain Director of Distribution (DOD) Email Address

Supplier/Distributor Name:

Supply Chain

Supplier/Distributor Customer #:

Have you contacted the Supplier/Distributor regarding this incident?

Yes

Attach a copy of the invoice with the item in question circled, pictures of the product in question, and the pictures of the case labels (showing lot code)

Lot # (from case label)

see link above for lot code guidance

Date product was received

Has affected product been placed on hold?

Yes

Distributor/Supplier Item Code:

Product Description:

Manufacturer Name: (ex: Tyson)

Manufacturer Item Code:

Has the product been left in inventory?

Yes

Operator Only

Significant Safety Event

Yes

Operator Initials

Is this an environmental issue or marine claim?

Environmental

Marine

Ocean/Marine

Vessel Description

Weather Condition

Is a marine company vessel damaged?

Yes

Vessel Name

Marine Hidden Coverage Major

Marine Hidden Status

Marine Hidden Intake Marine Incident Yes

6-Marine Hidden RecordTypeID

3-Marine Hidden Submit To TPA

Aramark Vessel Operator

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Aramark Vessel Operator Hidden ID

National Park Service investigate?

Yes

Authority Report Number

Authority Name

Vessel Damage Repaired

Repaired by AramarkRepaired by other than AramarkNot RepairedUnknown

Claimant First Name

Claimant Last Name

Were there any witnesses?

Yes

Unknown

Involved Parties

Were they an Aramark Employee?

Yes

What is their name?

Involved Party Type

Involved

Witness

Passenger (Auto incident)

Address

City

State

Zip Code

Best Contact Phone Number

Email address

Operator Only

Significant Safety Event

Yes

Operator Initials

Would you like to attach any necessary documents?

YesNo

Would you like to complete the SAFE Investigation now?

YesNoThis will be emailed out to you, and available in GMM if not conducted now

Click below to attach documents

SAFE Investigation

Was the equipment in use a factor in the incident?

Yes

Equipment

	Select all that apply
Equipment not functioning properly or in poor condition
Equipment used was not suitable for the task
Equipment not used as intended
Equipment not inspected before use
Employee not trained on use of equipment
Other

Please provide details:

Did the design, layout, or condition of the workplace contribute to the incident?

Yes

Workplace Layout/Conditions

	Select all that apply
Inadquate layout (insufficient space, broken door, floor holes)
Work area difficult to access
Inadequate warning signs in place (ex: Wet floor signs)
Housekeeping not to standard
Other

Please provide details:

Floor Conditions

	Select all that apply
Damaged floor surface (e.g. holes, uneven flooring)
Substance on floor
Obstacle on floor
Unsuitable floor mat
Defective Step(s) / Stairs
Other

Please provide details:

Environmental Conditions

	Select all that apply
Lighting not adequate
Temperature not suitable (too hot, too cold)
Inadequate ventilation
Weather conditions
Other

Please provide details:

Did procedures (or lack of) contribute to the incident?

Yes

Procedure or lack of

	Select all that apply
No procedure in place for the task
Inadequate procedure / procedure not followed
No employee training or documentation that covers this task
Insufficient information provided to contractor
Other

Please provide details:

Did PPE (Personal Protective Equipment) or lack of contribute to the incident?

Yes

Personal Protective Equipment (PPE)

	Select all that apply
Proper PPE not available
PPE available, but not used or maintained
PPE used, but poor fit or ineffective
Improper use of PPE
Not trained on proper use of PPE
Other

Please provide details:

Were there other contributing factors to the incident?

Yes

Other Contributing Factors

	Select all that apply
Fatigue
Acts of violence
Stress or rushed
Other

Please provide details:

Attachments & Documents

Add support documentation as an attachment

Corrective Action

Corrective Action: What actions have been taken to prevent this incident from happening again? Consider People Training, behaviors, PPE, environment design, layout, and equipment.

Person(s) Responsible

Is the Corrective Action complete?

Yes

Completion Date

Expected Completion Date

Please provide details:

Investigation completed by: