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Food allergy questionnaire template

Food allergy questionnaire template

Effectively manage food allergies with our detailed questionnaire template. Identify allergens, ensure safety, and maintain high standards. Download your free PDF from Lumiform today!

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Food allergy questionnaire template

Effectively manage food allergies with our detailed questionnaire template. Identify allergens, ensure safety, and maintain high standards. Download your free PDF from Lumiform today!

Use this template with Lumiform

  • Customize this template or build your own
  • Fill out templates via mobile app
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF

This food allergy questionnaire template helps you document and track food allergies with precision and care. The template includes sections for identifying specific allergens, reaction severity, emergency contact information, and medication requirements. When used in your food service operation, this questionnaire creates a standardized system for collecting critical allergy information that your kitchen staff needs to prevent cross-contamination and allergic reactions.

Studies show that 53.9% of food allergy reactions in restaurants occurred despite customers providing prior notification to staff, demonstrating the need for better documentation systems like this template that improve communication between front-of-house and kitchen staff.

Related categories

  • Health and safety management templates
  • Food manufacturing templates
  • Food safety templates
Preview of the template
Page 1
Food Allergies
Do you have any food allergies?
If yes, please list the specific food allergens:
When were you first diagnosed with food allergies?
Allergy Symptoms
What type of symptoms do you experience when exposed to your food allergen(s)?
How soon after exposure do your symptoms typically appear?
Have you ever required emergency medical treatment due to a food allergy reaction?
Allergy Management
Do you carry epinephrine auto-injectors (e.g. EpiPen) with you?
How often do you use your epinephrine auto-injector?
Have you received training on how to properly use your epinephrine auto-injector?

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Frequently asked questions

How can I ensure my food allergy questionnaire is compliant with privacy regulations?

Include a clear privacy statement explaining how the allergy information will be used, stored, and shared. Obtain explicit consent for data collection, limit access to authorized personnel only, and establish secure storage procedures. Consider consulting with a legal professional to ensure your questionnaire complies with relevant healthcare privacy laws in your region.

When should I distribute a food allergy questionnaire to customers?

Distribute your food allergy questionnaire during reservation processes, when taking catering orders, or upon entry for walk-in customers. For special events, send it 2-3 weeks in advance to allow time for menu adjustments. Some restaurants include a QR code on menus linking to the questionnaire for immediate access when customers identify themselves as having allergies.

How do I design a food allergy questionnaire that’s easy for customers to complete?

Create a clean, organized layout with clear section headings and simple instructions. Use checkboxes for common allergens and severity levels, with space for additional details. Avoid medical jargon and keep questions concise. Consider offering both digital and paper formats to accommodate different preferences, and test your questionnaire with a small group before full implementation.

What’s the best way to organize allergen information collected from questionnaires?

Create a centralized allergen database that’s accessible to relevant staff. Consider color-coding by allergen type or severity for quick visual reference. Update records regularly and implement a verification system where customers confirm their allergen information hasn’t changed upon return visits. Integrate the information with your ordering system for automatic alerts when allergenic ingredients are ordered.


This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.
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