Restaurant Allergen Communication Record
A dated record of exactly what you told a restaurant about your allergy — and what staff confirmed back.
When a reaction happens, it comes down to who said what
Allergen requests get passed from you to a server to a kitchen, verbally, in a few seconds at the table. When something goes wrong, there's rarely any record of what was actually disclosed, or what the restaurant confirmed back to you.
This record gives you a dated, written trail of the allergen you disclosed, who you told, and what was confirmed — evidence that matters if a reaction happens despite you doing everything right.
Step by step
- Log the allergen or intolerance disclosed, its severity, and the date/time.
- Record who you told — server name or role — and how (verbally, on an order app, or in writing).
- Note what was confirmed back to you, including any substitutions or kitchen changes agreed.
- If a reaction happens anyway, use the incident follow-up section to log symptoms and next steps immediately.
Anyone eating out with a food allergy or intolerance
Whether it's a severe allergy or an intolerance you'd rather avoid triggering, this gives you a real record of the conversation — not just a memory of it.
- Allergen disclosure log (what, severity, date/time)
- Staff confirmation field (who confirmed, what was agreed)
- Substitution and preparation notes
- Incident follow-up section if a reaction occurs — delivered as PDF
Get the conversation in writing.
A dated disclosure-and-confirmation record turns "I told them" into something you can actually show.
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