Foodborne Diseases (FDs) are a complex and relevant problem for global Public Health. World Health Organization highlighted the importance of FDs surveillance as a crucial instrument to guarantee health and food safety. Against this background European Union made investigation and reporting of foodborne outbreaks mandatory with Directive 2003/99/EC, which was transposed in Italy by D.Lgs n.191/2006. The “Surveillance system of foodborne disease” of Piemonte Region, active since 2002, through the years has been integrated with a One Health perspective. Nowadays, this surveillance system is based on the integrated analysis of information periodically collected from several institutions: FDs cases or outbreaks notifications from Hospitals and Local Health Services; alerts from general practitioners and private citizens; Results of analyses and serotyping of food samples (by Experimental Zooprophylactic Institute) and human biological specimens reported by the laboratory active surveillance. This surveillance system allows to monitor in Piemonte FDs’ outbreaks and single cases, as well as the pathogens circulating in the population. As observed in Europe, the data collected in 20 years show that the causative agents more common in Piemonte are Campylobacter spp. and Salmonella spp., and the most frequent risk factor is the consumption of raw or not properly preserved food. The main critical concerns of this surveillance system included some management difficulties, sometimes the lack of detection timeliness and the under-notification of FDs by the epidemiologic surveillance highlighted by the laboratory active surveillance. The Surveillance system of FDs in Piemonte is an important tool for monitoring, evaluating and reporting this challenging issue. To solve critical aspects of this system and enhance its effectiveness, all the participant institutions are currently cooperating for implementation measures. Indeed, thanks to cross-sectorial collaboration, it is possible to have an all-embracing perspective, fundamental for the prevention and improvement of public health and useful for policy makers.