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Food and Nutrition Concerns

INSTRUCTIONS FOR Food & Nutrition Complaint Form

Food and Nutrition Page 1 of 2 Complaint Form Instructions April 2019 The Food & Nutrition (F&N) Complaint Form is provided for persons wishing to file a complaint with F&N at the Texas Department of Agriculture. This form may be downloaded at For assistance with the complaint process, please call (833) 862-7499.

SECTION A (To File a Complaint)

1. CONTACT INFORMATION (of Person Filing Complaint)

  • Check if Anonymous
  • Select Complaint Type - Select complaint type from provided list and skip to Number 2 if Anonymous
  • First Name - Enter First Name
  • Last Name - Enter Last Name
  •  Phone and/or E-mail – Enter best telephone number and/or best e-mail address
  • Mailing Address – Enter street address
  • City, State, Zip Code – Enter City, State, and Zip Code


  • Name and address of Contracting Entity (CE) delivering service or benefit (if applicable) - Enter the name and address of the CE.
  • CE ID (if applicable) - If known, enter the Contracting Entity identification number assigned by TXUNPS.
  • If the complaint is against an individual, enter the name and contact information - If the complaint is about a TDA employee, enter his/her name, if known.
  •  Relationship to CE or individual - Enter the type of relationship you have with the Contracting Entity or individual (e.g., customer, employee or co-worker).
  •  Describe complaint in detail - Provide relevant details including names, dates, times and specific allegations. Please include documentation to support any allegations. Use second page if more space is needed.


SECTION B (Witness Information - If there is a witness or someone else who has knowledge of the incident)


  •  First Name - Enter First Name
  •  Last Name - Enter Last Name
  • Phone and/or E-mail - Enter best telephone number and/or best e-mail address
  • Mailing Address - Enter street address
  • City State Zip Code - Enter City, State and Zip Code


  • Signature - Unless anonymous, sign the form. Enter the date submitted.
  • Signature not available - Check box if signature is not available.
  •  Enter the date the Complaint Form was completed.


  •  Enter ESC Region - Select ESC region from drop down provided.
  • Enter F&N Region Area - Select Regional area from drop down provided.
  • Enter how the complaint was received - Select from the provided list how the complaint was received.
  • Internet Quorum /Footprint Ticket Number - Input IQ and/or Footprint ticket # assigned to this complaint upon input by Section Administrative Assistant.
  •  F&N Program Section - Select identified F&N Program participation.
  • F&N Receiving Staff/Title - F&N Staff member who received the complaint verbally will enter their Name and Title.
  • Date – Enter the date the complaint is received.
  • Referred To - F&N staff refers the F&N Formal Complaint form to Quality Assurance Quality Control (QAQC) Section. Enter the name of the QAQC Director and/or Coordinator who will assign the complaint for research as applicable.
  • Date - Enter the date the Complaint Form was referred.


Submit written complaints and any documentation to Poteet ISD Child Nutrition Department or TDA by mail, fax or by emailing a scanned copy.

If submitting a complaint via email, please submit the completed F&N Complaint Form and documentation to the following email address: or

If submitting a complaint via mail or fax, please submit the completed F&N Complaint Form and documentation to F&N:

Poteet ISD Child Nutrition Department 

Attn: Director of Child Nutrition

1100 School Dr.

Poteet, TX 78065

FAX: (830) 742-3332


F&N Headquarters

Texas Department of Agriculture, Food and Nutrition

P.O. Box 12847

Austin, Texas 78711

FAX: (888) 237-5226

A letter of acknowledgment will be sent (unless the anonymous box is checked) within one TDA business day of complaint receipt by the QAQC Section Administrative Assistant. In the event the letter of acknowledgment has not been received within one week, please call (833) 862-7499 for assistance