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* 1. Company Name

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* 2. Type of business (indicate all that apply)

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* 3. Location of Affected Division(s), (State or Province):

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* 4. Commodity formats handled:

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* 5. Sales Impact as a result of the outbreak (as a percent of typical sales for that product):

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* 6. Acres of product not harvested due to the outbreak:

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* 7. Miscellaneous Costs (Please describe cost and expand as required, also please note whether costs were in USD or CAD):

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* 8. How many contacts (calls, emails, etc.) did you receive related to the outbreak:

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* 9. Other Customer / Consumer Impact (Please briefly describe the impact this issue had on your customers (business) or consumers (retail / food service):

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* 10. Please provide us with any other comments which we should bring to the government(s) attention:

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* 11. Please provide us with any comments you have for the industry associations on how you would like future incidents to be managed, communicated, etc.

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