A Multistate Outbreak of E

Module 2 – Group Exercise: Collecting a Food History

Divide into groups of two. One person will be the interviewer; one will be the complainant.

1.  The person playing the interviewer should try to solicit a 5-day food history from the complainant.

2.  The person playing the complainant should respond to questions from the interviewer as if they just developed symptoms of a foodborne illness that day and based on what they really ate in the last 5 days.

3.  Was it easy or difficult? Did you get a complete food history? What approaches were helpful?

Day of Illness Onset (enter date):
Breakfast: ______Location: ______Time: ______AM / PM ______Suspect Meal? Yes No
______Contacts:______
Lunch: ______Location: ______Time: ______AM / PM
______Suspect Meal? Yes No
______Contacts:______
Dinner: ______Location: ______Time: ______AM / PM
______Suspect Meal? Yes No
______Contacts:______
Other Foods/Water: ______Location: ______Time: ______AM / PM
______Suspect Meal? Yes No
One Day Prior to Illness Onset (enter date):
Breakfast: ______Location: ______Time: ______AM / PM ______Suspect Meal? Yes No
______Contacts:______
Lunch: ______Location: ______Time: ______AM / PM
______Suspect Meal? Yes No
______Contacts:______
Dinner: ______Location: ______Time: ______AM / PM
______Suspect Meal? Yes No
______Contacts:______
Other Foods/Water: ______Location: ______Time: ______AM / PM
______Suspect Meal? Yes No
Two Days Prior to Illness Onset (enter date):
Breakfast: ______Location: ______Time: ______AM / PM ______Suspect Meal? Yes No
______Contacts:______
Lunch: ______Location: ______Time: ______AM / PM
______Suspect Meal? Yes No
______Contacts:______
Dinner: ______Location: ______Time: ______AM / PM
______Suspect Meal? Yes No
______Contacts:______
Other Foods/Water: ______Location: ______Time: ______AM / PM
______Suspect Meal? Yes No
Three Days Prior to Illness Onset (enter date):
Breakfast: ______Location: ______Time: ______AM / PM ______Suspect Meal? Yes No
______Contacts:______
Lunch: ______Location: ______Time: ______AM / PM
______Suspect Meal? Yes No
______Contacts:______
Dinner: ______Location: ______Time: ______AM / PM
______Suspect Meal? Yes No
______Contacts:______
Other Foods/Water: ______Location: ______Time: ______AM / PM
______Suspect Meal? Yes No
Four Days Prior to Illness Onset (enter date):
Breakfast: ______Location: ______Time: ______AM / PM ______Suspect Meal? Yes No
______Contacts:______
Lunch: ______Location: ______Time: ______AM / PM
______Suspect Meal? Yes No
______Contacts:______
Dinner: ______Location: ______Time: ______AM / PM
______Suspect Meal? Yes No
______Contacts:______
Other Foods/Water: ______Location: ______Time: ______AM / PM
______Suspect Meal? Yes No

Small Group Exercise: Collecting a Food History – p. 1