• Grocery Rescue Feedback Form

    The Grocery Rescue Program Feedback Form is to be used in the event that a partner site needs to report food safety, product quality, or other concerns related to the Grocery Rescue Program. There are specific pieces of information needed to enable SHFBOC to complete an effective follow-up/investigation. Please collect as much information available from the partner and ensure you capture pictures of the product(s) for review by our Sourcing Team. Submit the completed feedback form and pictures no later than two-business days after receipt of products to your respective Grocery Rescue Coordinator. *Please only fill out this form when there is 15% spoilage or more*

  • Dates 

    Please Indicate what day you are completing this form by and the date the product that was picked up 

  • 1. Form Completed on (Date) *
     - -
    2 digit month, 2 digit day, 4 digit year
  • 2. Product picked-up on (Date) *
     - -
    2 digit month, 2 digit day, 4 digit year

  • Partner Site Information 

  • Food Feedback Information 

    The purpose of this section is to help SHFB gain context about what challenge you faced at the store pickup. This section ONLY applies to the donation itself.

  • 10. What was wrong with the donation (Please check all that apply)*
  • 13. When was the product inspected?*
  • 14. Is this the first time this has occurred?*
  • 15. What is the status of this product?*
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • Non-Food Feedback Information

    This section is ONLY to be filled out when you have feedback that does not involve the donation itself but, it is something that still needs to be addressed. This can include but is not limited to; negative contact with receiver or team member, discrimination of any type, or consistently long wait times at a store.
    Please do not hesitate to reach out to your respective Grocery Rescue Coordinator if you have any questions.

  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • Food that Resulted in Injury or Illness

    This section is ONLY to be filled out by the client/participant who was injured or ill

  • Format: (000) 000-0000.
  • Date Symptoms Started
     - -
    2 digit month, 2 digit day, 4 digit year
  • What is the status of the product?
  • Did the individual require medical attention
  • Was the health department notified?
  • Should be Empty: