Foodborne Disease Reporting Form - Minnesota Dept. of Health

Foodborne Disease Reporting Form

This form can be used to report amebiasis, campylobacteriosis, cryptosporidiosis, cyclospora, E. coli infection, giardiasis, listeriosis, salmonellosis, shigellosis, trichinosis, vibrio, or yersiniosis to the Minnesota Department of Health.

On this page:
Frequently asked questions
Diseases to report on this form
Returning the completed form
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Download a print version of the form:

Frequently asked questions

  • If you have questions regarding this form, please call 651-201-5414.

  • When reporting on this form, a Yellow Card is not necessary.
    yellow card

Diseases to report this form

Returning the completed form

  • After filling out this form, please return to MDH:

    • By mail (please mark the envelope "confidential") to:
      Infectious Disease Epidemiology, Prevention and Control
      625 North Robert Street
      Post Office Box 64975
      St. Paul, MN 55164-0975
    • By fax to:
      651-201-5743 or 651-215-9007

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Updated Wednesday, December 16, 2015 at 08:22AM