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TABLE OF CONTENTS
 

INTRODUCTION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
 

FOODBORNE ILLNESS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
 

EMPLOYEE HEALTH AND THE FOOD ESTABLISHMENT . . . . . . . . . . . . . . . . . . . . 7
 

EMPLOYEE HEALTH - MANAGEMENT RESPONSIBILITIES . . . . . . . . . . . . . . . . . . . . 9
 

EMPLOYEE HEALTH - EMPLOYEE RESPONSIBILITIES . . . . . . . . . . . . . . . . . . . . . . 13
 

EMPLOYEE HEALTH - EXCLUSIONS AND RESTRICTIONS . . . . . . . . . . . . . . . . . . . . 15
 

EMPLOYEE HEALTH AND THE AMERICANS WITH DISABILITIES ACT. . . . . . . . . . . 19
 

EMPLOYEE HEALTH AND HIGHLY SUSCEPTIBLE POPULATIONS . . . . . . . . . . . . . . 23
 

PERSONAL HYGIENE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
 

NO BARE HAND CONTACT WITH READY-TO-EAT FOODS . . . . . . . . . . . . . . . . . . 29
 

FORMS, TABLES, AND DECISION TREES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
 

FORM 1-A Conditional Employee and Food Employee Interview . . . . . . . . . . . . . . . . . 33
 

FORM 1-B Conditional Employee or Food Employee Reporting Agreement . . . . . . . . . 37
 

FORM 1-C Conditional Employee or Food Employee Medical Referral . . . . . . . . . . . . . 39
 

FORM 1-D Application for Bare Hand Contact Procedure . . . . . . . . . . . . . . . . . . . . . . . 41
 

2-201.12 Table 1a: Summary of Requirements for Symptomatic Food Employees . . . . 43
 

2-201.12 Table 1b: Summary of Requirements for Diagnosed, Symptomatic
 

Food Employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
 

2-201.12 Table 2: Summary of Requirements for Diagnosed Food Employees 

with Resolved Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
 

2-201.12 Table 3: Summary of Requirements for Diagnosed Food Employees 

Who Never Develop Gastrointestinal Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
 

2-201.12 Table 4: History of Exposure, and Absent Symptoms or Diagnosis . . . . . . . . . 55
 

2-201.11 / 2-201.12 Decision Tree 1. When to Exclude or Restrict a 

Food Employee Who Reports a Symptom and When to Exclude a 

Food Employee Who Reports a Diagnosis with Symptoms Under the Food Code . . . . 57
 

2-201.11 / 2-201.12 Decision Tree 2. When to Exclude or Restrict a 

Food Employee Who is Asymptomatic and Reports a Listed Diagnosis 

and When to Restrict a Food Employee Who Reports a Listed Exposure 

Under the Food Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
 

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INTRODUCTION
 

The Food and Drug Administration (FDA) has developed this Employee Health and Personal 

Hygiene Handbook to encourage practices and behaviors that can help prevent food employees 

from spreading viruses and bacteria to food. It provides information in a question-and-answer 

format that food establishment management and food employees can use to prevent the spread of 

disease. This handbook also provides easy reference to forms and tables that food establishments 

and the public health community may find useful when training staff and addressing employee 

health and hygiene matters. The information in this handbook is taken from those provisions 

in the 2005 FDA Food Code and its Supplement aimed at preventing ill food employees from 

transmitting disease. 

The Centers for Disease Control and Prevention (CDC) and FDA cite five highly infective 

pathogens that can easily be transmitted by food workers and cause severe illness. These five 

foodborne pathogens, also known as the “Big 5,” include Norovirus, the Hepatitis A virus, Salmonella 

Typhi, Shigella spp., and Escherichia coli (E.coli) O157:H7 or other Enterohemorrhagic or Shiga 

toxin-producing E. coli. Other, less infectious pathogens that can also be transmitted by food 

employees to consumers through contaminated food include Staphylococcus aureus, Salmonella 

spp., and Streptococcus pyogenes. 

This handbook highlights a combination of three interventions that can be effective in prevention 

of the transmission of foodborne viruses and bacteria in food establishments. These interventions 

include: (a) restricting or excluding ill food employees from working with food; (b) using proper 

handwashing procedures; and (c) eliminating bare hand contact with foods that are ready-to-eat 

(RTE). Concurrent use of each intervention will help prevent the transmission of viruses, bacteria, 

and protozoan oocysts from food employees to consumers through contaminated food. 

Proper management of a food establishment involves ensuring that food employees do 

not work when they are ill and having procedures for identifying employees who may transmit 

foodborne pathogens to food, other employees, and customers. 

Management must ensure that food employees and “conditional” hires alike are aware of the 

reporting requirements for foodborne illness symptoms and diagnoses. When a food employee 

or conditional food employee reports either an exposure to, symptoms of, or a diagnosis with 

foodborne illness, the person in charge (PIC) must take action to prevent the transmission of 

foodborne bacteria and/or viruses from the infected food employee to the food. The PIC must 

understand the requirements for restricting, excluding, and reinstating food employees. 

A correlation between the severity of a food employee’s clinical illness and the level of exclusion 

and restriction required to eliminate the risk has been established. These levels were created to 

protect public health while avoiding unnecessary disruption to the employee schedule and the 

retail establishment’s operation. 

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Proper handwashing reduces the spread of fecal-oral pathogens from the hands of a food 

employee to foods. Handwashing can also help reduce the transmission of other pathogens from 

environmental sources. Effective handwashing includes scrubbing, rinsing, and complete drying 

of hands and is essential for minimizing the likelihood of cross-contamination. The fingernails 

and surrounding areas are often the most contaminated parts of the hand and are also the most 

difficult part of the hand to get clean. Every stage of handwashing is equally important and has 

an effect in reducing contamination of the hands. 

Handwashing alone might not always successfully remove pathogens from heavily 

contaminated hands, and infected food employees may not always be identified and removed 

from food preparation activities. 

“No Bare Hand Contact” is the practice of preventing direct contact with bare hands while 

handling RTE foods. This practice provides a secondary protection against the contamination 

of foods that do not require further cooking with microbial pathogens from the hands of ill food 

employees. 

The 2005 FDA Food Code recognizes the increased risks of foodborne illness in highly 

susceptible populations (HSPs) such as the very young, older adults, and those with compromised 

immune systems. Food establishments in health care; assisted living, child or adult day care, 

hospitals, nursing homes, nursery schools, and senior citizen centers are required to take 

additional precautions to prevent the transmission of foodborne illness. 

For additional information about food safety, employee health and hygiene, and prevention of 

foodborne illness, go to the FDA/Center for Food Safety and Applied Nutrition’s (CFSAN’s) Retail 

Food web page at: http://www.cfsan.fda.gov/~ear/retail.html. 

SOURCE: 

Adapted from the 2005 FDA Food Code and its Supplement, U.S. Department of Health and 

Human Services, Public Health Service, Food and Drug Administration 

http://www.cfsan.fda.gov/~dms/fc05-toc.html (FDA 2005 Food Code) 

http://www.cfsan.fda.gov/~dms/fc05-su2.html (Supplement to the 2005 Food Code) 

Acknowledgements: 

• FDA National Retail Food Team-Marketing Work Group 

• FDA CFSAN Retail Food Protection and Cooperative Programs Coordination Staff/ 

Retail Food Protection Team 

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FOODBORNE ILLNESS
 

What causes foodborne illness? 

Over 40 different kinds of bacteria, viruses, parasites, and molds that may occur in food 

can cause foodborne illness. A foodborne illness is commonly referred to as food poisoning or 

“stomach flu.” 

What is a foodborne illness outbreak? 

An outbreak is two or more confirmed cases of a similar illness resulting from the ingestion of 

a common food. 

Who is affected by foodborne illness? 

The general population is at risk for foodborne illness. Those individuals categorized as part of 

a Highly Susceptible Population (HSP) are more likely to experience a severe case of foodborne 

illness because they are: 

•	 Immunocompromised, that is, have an immune system which has been impaired 

by disease or medical treatment; 

•	 Preschool-age children; 

• Elderly; 

• Sick; or 

• Confined to facilities that provide custodial care. 

What are the “Big 5” foodborne pathogens? 

The Big 5 is a group of highly infectious foodborne pathogens. These Big 5 pathogens have 

a low infectious dose, contaminate the gastrointestinal system after ingestion, and are shed in 

feces. These pathogens shed in high numbers. A food employee infected with a Big 5 pathogen 

will typically shed hundreds of thousands of pathogens in their feces that can be easily transmitted 

to food even when good handwashing practices are used. Consequently, the illness experienced 

by the consumer can be very severe. 

The Big 5 includes: 

• Norovirus; 

•	 Salmonella Typhi (typhoid-like fever); 

•	 E. coli O157:H7, Enterohemorrhagic or Shiga toxin-producing E. coli; 

•	 Shigella spp. (causes shigellosis); and 

• Hepatitis A virus. 

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What are the common symptoms of foodborne illness? 

Common symptoms of foodborne illness typically include diarrhea and/or vomiting. 

What is a common symptom of the hepatitis A virus? 

Jaundice, a common symptom of the hepatitis A virus, often results in a yellowing of the skin, 

mucous membranes, and white portion of the eyes. 

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EMPLOYEE HEALTH AND 

THE FOOD ESTABLISHMENT
 

What symptoms of foodborne illness should food establishments 

be most concerned about? 

Food establishments should be most concerned about the following symptoms: 

• Vomiting 

• Diarrhea 

•	 Jaundice (yellow skin or eyes) 

•	 Sore throat with fever 

•	 Infected cuts and burns with pus on hands and wrists 

What should food employees do when they have symptoms of vomiting 

or diarrhea? 

If at work: 

•	 Stop work immediately; 

•	 Report to management; and 

•	 Go home and return after at least 24 hours have passed since the 

vomiting and diarrhea symptoms ended. 

If the symptoms occur before the employee arrives to work, he or she should: 

•	 Notify the manager by telephone; and 

•	 Do not report to work until at least 24 hours have passed after the 

diarrhea and vomiting symptoms have ended.
 

What should food employees do if they are not feeling well and their skin or eyes 

turn yellow? 

Report the symptoms to their manager or employee health department immediately and seek 

medical attention. The employee should not return to work until after receiving clearance from a 

health practitioner. If the employee is jaundiced for more than 7 days, clearance from the local 

health department is required. 

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What should food employees do if they have an infected wound or cut on their 

hand or arm? 

Report the wound or cut to the manager, and then properly cover it with a clean, impermeable 

bandage and a single-use glove (for hand wounds), before returning to work. 

What should food employees do if they have a sore throat with fever? 

Report the illness to the manager and, if possible, continue working while remaining aware 

that the manager could consider reassignment to a position that does not include the handling 

of food, food-contact equipment, utensils, or single-service articles. If the employee works in a 

food establishment serving an HSP, such as a hospital, nursing home, assisted living facility, or a 

day care center, the employee must stop working and go home until obtaining a clearance from a 

health practitioner and presenting it to the manager. 

Where can food employees learn more about preventing foodborne illness and 

following effective food safety practices? 

Foodborne illness information resources: 

FDA/CFSAN Foodborne Illness link 

http://www.cfsan.fda.gov/~mow/foodborn.html 

The “Bad Bug Book” (Foodborne Pathogenic Microorganisms and Natural Toxins Handbook) 

http://www.cfsan.fda.gov/~mow/intro.html 

CDC National Center for Infectious Diseases 

http://www.cdc.gov/ncidod/diseases/food/index.htm 

Gateway to Government Food Safety Information 

http://www.foodsafety.gov 

You can also get information from a state or local health department, the U.S. Department of 

Agriculture, a tribal authority, or a public research university or extension program. 

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EMPLOYEE HEALTH - MANAGEMENT RESPONSIBILITIES 

What is a food establishment manager’s responsibility for ensuring 

that food employees are trained on the reporting of symptoms 

and the diagnosis of foodborne illness? 

The manager or PIC is to make certain that food employees are trained on the subject of the: 

•	 Causes of foodborne illness; 

•	 Relationship between the food employee’s job task, personal hygiene, and 

foodborne illness;
 

•	 Requirements for reporting; and 

• Specific symptoms, diagnoses, and exposures that must be reported to the PIC. 

What is a manager’s responsibility regarding informing food employees 

of their reporting requirements? 

(See Form 1-B and refer to Guide 3-C in Annex 7 of the 2005 Food Code) 

Management should explain to food employees the importance of reporting specifi c symptoms 

and any diagnoses or exposures to foodborne illness. Things to be reported to management 

include: 

•	 Vomiting, diarrhea, jaundice, sore throat with fever, or any exposed boil or open, infected 

wounds or cuts on the hands or arms; 

•	 An illness diagnosed by a health practitioner that was caused by: Salmonella Typhi 

or typhoid-like fever, Shigella spp., Norovirus, hepatitis A virus, E. coli O157:H7 or other 

Enterohemorrhagic or Shiga toxin-producing E. coli; 

•	 Past illnesses with typhoid-like fever within the past 3 months, unless treated 

with antibiotics; and
 

•	 Exposure to typhoid-like fever, shigellosis, Norovirus, hepatitis A virus, E. coli O157:H7 

or other Enterohemorrhagic or Shiga toxin-producing E. coli, by eating or serving food 

that was implicated in a foodborne illness outbreak or if residing with a diagnosed 

individual. 

What should a manager do when a food employee reports symptoms of vomiting 

or diarrhea? 

(See Decision Tree 1 and Table 1a (and Table 1b if diagnosed)) 

Ask the food employee to stop work immediately and leave the food establishment. Permit a 

return to work no sooner than 24 hours after vomiting and diarrhea have ended. 

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What should a manager do when a food employee reports symptoms of jaundice? 

(See Decision Tree 1 and Table 1a) 

• Have the food employee stop work immediately. 

• Inquire about how long the employee has been experiencing jaundice or associated 

symptoms of jaundice. 

• Have the food employee leave the food establishment if he or she has had jaundice or 

has been experiencing symptoms of jaundice for less than 7 days. 

• Report cases of jaundice to the regulatory authority and have the food employee’s return 

to work approved by a regulatory authority. 

What should a manager do when a food employee reports symptoms 

of sore throat with fever? 

(See Decision Tree 1 and Table 1a) 

• Place the employee on restricted duty, that is, no working with or around food. 

• Allow food employees to return to work with written medical documentation 

from a health practitioner. 

• If the food employee works in a facility that serves an HSP, exclude the food employee 

from the food establishment. 

What should a manager do if a food employee has or reports an exposed boil 

or infected wound that is open and/or draining on the hands or arms? 

(See Decision Tree 1 and Table 1a) 

Restrict any employee from working with food who has an infected skin lesion with pus, like a 

boil or infected wound that is not properly covered. The manager can lift the restriction once the 

infected area is properly covered or healed. 

What should the manager of a food establishment serving an HSP do if an 

employee reports an exposure to foodborne illness? 

(See Decision Tree 2 and Table 4) 

Restrict the food employee and make sure that training is provided about: 

• The foodborne illness and related symptoms; 

• Handwashing procedures; 

• The prevention of bare hand contact with RTE foods; and 

• The length of restriction and what is required to have the restriction lifted. 

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The manager must restrict food employees exposed to: 

•	 Norovirus, for at least 48 hours from the time of exposure; 

•	 Shigella spp. or E. coli O157:H7, for at least 3 days from exposure; 

•	 Salmonella Typhi, for at least 14 days from exposure; or 

•	 Hepatitis A virus, until after training has been given about symptoms, the use of bare 

hand contact with RTE food to avoid contamination, proper handwashing, or until at least 

30 days from the initial exposure. 

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EMPLOYEE HEALTH - EMPLOYEE RESPONSIBILITIES
 

Do food employees have a responsibility to prevent foodborne illness? 

Yes, food employees share the responsibility with management for preventing foodborne 

illness and are required to know: 

•	 The relationship between their job responsibilities and the potential risks 

of foodborne illness;
 

•	 How employee health is related to foodborne illness; 

•	 The need to immediately report symptoms of vomiting, diarrhea, jaundice, sore throat 

with fever, diagnosis of illness caused by a Big 5 pathogen, exposure to a Big 5 

pathogen, or an exposed infected wound or cut on the hands or arms to their manager 

(see Form 1-B); 

•	 How restriction and/or exclusion from working with food prevents foodborne illness; and 

•	 How proper hand hygiene and no bare hand contact with RTE food can prevent 

foodborne illness.
 

Can food employees work if their symptoms are from a non-infectious condition? 

Yes, food employees can work as long as they can provide medical documentation indicating 

that the symptoms are from a non-infectious condition. Some non-infectious conditions include 

Crohn’s disease (an ongoing disorder that causes inflammation of the gastrointestinal system), 

irritable bowel syndrome, some liver diseases, and symptoms commonly experienced during 

stages of pregnancy. 

If an infected wound, cut, or burn is covered, can employees continue working? 

Yes, food employees can continue working as long as the wound, cut, or burn is properly 

covered with a waterproof cover like a finger cot and a disposable glove, or a dry, durable, tightfi tting bandage. 

What types of exposure must food employees report to management? 

If a food employee is exposed to any of the following situations, it must be reported, such as 

in cases of: 

•	 Ingesting or handling food that was implicated in a foodborne outbreak; 

•	 Consuming food that was prepared by someone with an illness that resulted from one of 

the Big 5 pathogens; 

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• Attending or working in a location that had a confirmed foodborne illness outbreak; 

• Living with someone who works or was in a location that was known to have had a 

foodborne illness outbreak; or 

• Living with someone who was diagnosed with an illness that resulted from one of the 

Big 5 pathogens. 

What other precautions can a food employee take to prevent the spread 

of foodborne illness? 

Food employees can help prevent foodborne illness by: 

• Not touching RTE food with bare hands; 

• Washing hands frequently, especially whenever they are soiled or have touched anything 

that has contaminated them; 

• Not working when ill; 

• Knowing all aspects of food handling and the risk factors associated with foodborne 

illness; and 

• Being aware that uncontrolled risk factors can cause consumers to have foodborne 

illness. 

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EMPLOYEE HEALTH - EXCLUSIONS AND RESTRICTIONS 

What is “exclusion”? 

Exclusion means a food employee is not permitted to work in or enter a food establishment 

as a food employee. This requirement applies to areas where food is received, prepared, stored, 

packaged, served, vended, transported, or purchased. 

What is “restriction”? 

Restriction means a food employee’s activities are limited to prevent the risk of transmitting a 

disease that is transmissible through food. A restricted employee cannot work with exposed food, 

clean equipment, utensils, linens, or unwrapped single-service or single-use articles. 

Who can exclude or restrict a food employee? 

The PIC of an establishment has the authority to exclude or restrict a food employee from a 

food establishment to prevent the transmission of disease through food. The regulatory authority 

also has the authority to exclude or restrict a food employee who is suspected of being at risk of 

transmitting foodborne illness. 

When is an exclusion or a restriction initiated? 

The need for exclusions and restrictions is based on the level of risk for transmitting disease 

through food. Four levels of risk determine when to apply exclusions and restrictions. The levels 

range from the highest risk to public health, which consists of active symptoms of diarrhea, 

vomiting, or jaundice, to the lowest risk level, wherein individuals are well but have been exposed 

to one of the Big 5 pathogens. 

The appropriate action also depends on whether or not the establishment is one that serves 

HSPs. 

Keep in mind that excluded individuals may not work in a food establishment in any capacity 

although they can enter the establishment as a customer. If food employees are restricted 

or excluded in one food establishment, they may not work as unrestricted food employees 

elsewhere. 

Further, a restricted food employee’s job duties must not allow contact with exposed food, 

utensils, food equipment, single-service or single-use articles, or linens. Job duties for restricted 

individuals may include working as a cashier, seating patrons, bussing tables, stocking canned or 

other packaged foods, or working in non-food cleaning or maintenance tasks. 

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To simplify when to exclude or restrict employees, refer to the decision trees and tables that 

are available in this handbook as well as the 2005 FDA Food Code and its Supplement. 

• See Tables 1a and 1b in this handbook and in the 2005 FDA Food Code, for the 

appropriate action to take if symptoms are reported. 

• See Table 2 in this handbook and in the 2005 FDA Food Code, for the appropriate 

action to take if the diagnosis reported is Norovirus, shigellosis, or E. coli O157:H7 or 

other Enterohemorrhagic E. coli and symptoms have been resolved. 

• See Table 3 in this handbook and in the 2005 FDA Food Code, for the appropriate action 

to take if the diagnosis reported is typhoid fever (S. Typhi) or hepatitis A, but the food 

employee is asymptomatic (never develops symptoms). 

• See Table 3 in this handbook and in the 2005 FDA Food Code, for the appropriate action 

to take if the diagnosis reported is Norovirus, shigellosis (Shigella spp.), E. coli O157:H7 

or other Enterohemorrhagic E. coli, but the food employee is asymptomatic (never 

develops symptoms). 

What actions should the PIC take when employees or conditional employees 

report exposure without being diagnosed or experiencing symptoms of 

foodborne illness? 

The PIC must take action to prevent the transmission of foodborne bacteria and viruses from 

infected food workers to food. Use the information below to determine whether the appropriate 

action to take is to use exclusion or restriction, or to simply increase awareness concerning 

handwashing and handling of food. Consult the local regulatory authority or food inspector to 

confirm how state or local codes and ordinances may apply. 

In establishments serving an HSP: 

• Restrict employees exposed to: Typhoid fever, shigellosis, Norovirus, and 

E. coli O157:H7 or other Enterohemorrhagic or Shiga toxin-producing E. coli. 

For an employee exposed to the hepatitis A virus, the PIC should: 

• Restrict the employee; 

• Educate the employee about strict adherence to handwashing procedures to ensure that 

no bare hand contact is occurring with RTE food for at least 30 days; or 

• Obtain medical documentation of immunity through a previous hepatitis A virus infection, 

previous immunization, or IgG vaccination. 

In establishments serving the general public, educate exposed employees about reporting, 

symptoms, diagnosis, handwashing, and no bare hand contact with RTE food. 

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Who can lift the exclusions and restrictions? 

In many cases, the manager or PIC removes, adjusts, or retains the exclusion or the restriction. 

In some cases, an approval from a regulatory authority and a medical practitioner is required to 

lift an exclusion or restriction. 

Allowing food employees to return to work after restriction or exclusion depends on several 

factors. Each of the Big 5 foodborne pathogens has unique characteristics of its illness. How long 

pathogens are shed in the stool and vomit affects when a food employee can return to work. 

Considerations for the PIC include: 

• Was the employee asymptomatic? 

• Is medical documentation required? 

• Is regulatory authority approval required for return to work? 

Note: Consult with your local jurisdiction, and use the following instructions to 

determine when an employee may return to work after restriction or exclusion. 

Further details are available in this handbook and in section 2-201.12, Tables 1a-4 

in Annex 3 - Public Health Reasons/Administrative Guidelines of the 2005 Food Code. 

• See Table 1a in this handbook and in the 2005 FDA Food Code for information on 

when to reinstate an employee who was restricted or excluded only because of 

symptoms. 

• See Table 1b in this handbook and in the 2005 FDA Food Code for information on when 

to reinstate an employee who was excluded or restricted because of a diagnosis with or 

without symptoms. 

• See Table 4 in this handbook and in the 2005 FDA Food Code for information on when 

to reinstate an employee who was restricted at a facility serving an HSP because of a 

history of exposure with no following symptoms or diagnosis. 

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EMPLOYEE HEALTH AND THE 

AMERICANS WITH DISABILITIES ACT
 

What is Title 1 of the Americans with Disabilities Act of 1990 (ADA)? 

Title I of the ADA is a federal law that prohibits private employers, state and local governments, 

employment agencies and labor unions from discriminating against qualified individuals with 

disabilities in job application procedures, hiring, firing, advancement, compensation, job training, 

and other terms, conditions, and privileges of employment. 

Title I also limits an employer’s ability to make disability-related inquiries and require medical 

examinations at three stages of the employment relationship – pre-offer, post-offer, and during 

employment: 

•	 Prior to extending a conditional offer of employment, employers may not ask any 

disability-related questions or require medical examinations, even if related to the job. 

This means that employers may not ask job applicants about the existence, nature, or 

severity of a disability. 

•	 Once a conditional offer of employment is made, an employer may make disabilityrelated inquiries and conduct medical examinations, regardless of whether they are 

related to the job, as long as the employer does so for all entering employees in the 

same job category. 

•	 After employment begins, an employer may make disability-related inquiries and require 

medical examinations only if they are job-related and consistent with business necessity. 

Should a food establishment make a conditional offer of employment 

prior to making inquiries about an applicant’s medical health status? 

Yes, in order to comply with the ADA and the FDA Food Code, a food establishment must make 

a conditional job offer to the potential food employee before making medical inquiries. Once a 

conditional job offer is made, employers may ask medical questions and require medical exams, 

as long as employers treat all applicants the same for the same type of job. See Form 1-A. 

Does the ADA require that employers provide reasonable accommodations 

to qualified job candidates and employees with disabilities? 

Yes. A reasonable accommodation is a change in the work environment or in the way a 

job or parts of a job are customarily done that enables a person with a disability to enjoy equal 

employment opportunities. 

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What should an employer do if a food employee who has been excluded due to 

an illness resulting from a Big 5 pathogen requests a reasonable accommodation 

under the ADA? 

For most people, having a disease resulting from one of the Big 5 pathogens does not 

constitute having a disability under the ADA. These diseases are usually short-term. If a person 

does not have an ADA disability, the food service employer may follow the Food Code’s guidance 

on exclusions without considering the ADA. However, the employer should not assume that a 

disease resulting from a Big 5 pathogen is never a disability. If an employee requests a reasonable 

accommodation after being excluded, the employer should question the employee to determine 

whether he or she is an individual with a disability due to the illness caused by one of the Big 5.1 

Even if the individual has a disability resulting from a Big 5 pathogen, the ADA allows an 

employer to refuse to assign or continue to assign the employee to a job involving food handling, 

as long as the risk of transmitting the disease cannot be eliminated by reasonable accommodation. 

See 42 U.S.C. 12113(d)(3). 

If the employee is disabled by one of the foodborne diseases listed in the Food Code, the 

employer may continue to exclude the employee only if the employer determines that: 

• There is no reasonable accommodation at work that would eliminate the risk of 

transmission of the disease while at the same time allowing the employee to work in a 

food handling position; or 

• All possible reasonable accommodations would pose an undue hardship on the 

employer’s business; and 

• There is no vacant position not involving food handling for which the employee is 

qualified and to which the employee can be reassigned. 

Should job applicants and food employees provide information to their employer 

that would help to identify whether a fellow employee is suffering from a disease 

that can be transmitted through food? 

Yes. Reporting information related to health status of other employees is required. Once the 

PIC is notified, appropriate action can be taken to prevent the likelihood of the transmission of 

foodborne illness. 

Under the ADA, the CDC must annually publish a list of infectious and communicable diseases. 

The list includes pathogens, such as viruses and other microorganisms, often transmitted by food 

contaminated by infected persons who handle food. The list also describes the methods by which 

such diseases are transmitted. The ADA has special rules for people in food handling jobs who 

have diseases due to the pathogens on the CDC list. See 29 C.F.R. § 1630.16(e). 

1 

 The Food Code also requires that employees who have certain symptoms associated with foodborne illnesses be 

excluded or restricted from performing certain functions, such as food handling. It is very unlikely, however, that a 

person who has not been diagnosed with a disease, and has only one or more of the symptoms listed in the Food Code, 

has an ADA disability by virtue of these symptoms alone. 

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Employers may follow state or local communicable disease reporting laws that are in 

accordance with the CDC list and are designed to protect public health from individuals who 

pose a significant risk to the health and safety of others, where that risk cannot be eliminated by 

reasonable accommodation. See 29 C.F.R. § 1630.16(e)(2). 

The CDC’s List of Infectious and Communicable Diseases that are transmitted through handling 

the food supply and the methods by which such diseases are transmitted can be found within the 

Federal Register Notice of Vol. 71, No. 186 / Tuesday, September 26, 2006, at http://frwebgate. 

access.gpo.gov/cgi-bin/getpage.cgi?dbname=2006_register&position=all&page=56152. 

Where is specific information about disabilities and ADA requirements found? 

Information about the ADA is available in “How to Comply with the Americans with Disabilities 

Act: A Guide for Restaurants and Other Food Service Employers,” at: 

http://www.eeoc.gov 

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EMPLOYEE HEALTH AND HIGHLY 

SUSCEPTIBLE POPULATIONS
 

Every effort must be made to closely monitor the food preparation operations for the highly 

susceptible population (HSP). Managers and food employees must take the needed precautions 

to prevent the spread of infectious pathogens and viruses to this vulnerable group of people. 

What makes a population highly susceptible? 

A population is highly susceptible to foodborne illness if it is: 

•	 Immunocompromised, preschool-age children, older adults, and individuals who obtain 

food at a facility that provides services such as custodial care, health care, or assisted 

living, or in a child or adult day care center, kidney dialysis center, hospital, nursing 

home, or nutritional or senior center. 

What should the manager of a food establishment serving an HSP do to help 

protect the HSP from exposure to viruses and harmful pathogens? 

•	 Carefully follow protocols for exclusion and restriction, adjusting and reinstating food 

employees’ work status in the establishment. 

•	 Ensure that employees are properly trained in food safety as it relates to their duties and 

use additional safeguards required for working in an HSP. 

•	 Reinforce employee compliance to guarantee good hygienic practices, acknowledge 

onset of symptoms, meet reporting requirements, and ensure no bare hand contact with 

RTE food by educating food employees on the importance of following this best practice. 

•	 Ensure that employees have access to facilities that are well-maintained, and have the 

necessary supplies available to follow proper hygienic practices. 

What can food employees do to help prevent the spread of disease in a 

food establishment that serves an HSP? 

•	 Comply with meeting reporting requirements and informing their manager if they are 

experiencing vomiting, diarrhea, jaundice, and/or sore throat with fever. 

•	 Keep hands and arms clean. 

•	 Follow proper handwashing procedures. 

•	 Wash hands as required using designated handwashing sinks only. 

• Maintain trimmed fingernails. Edges and surfaces should be smooth and cleanable. 

•	 Do not wear jewelry on hands and arms except for a plain ring, like a wedding band. 

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• Use single-use gloves for one task. If the gloves are damaged or soiled or when 

interruptions occur in the process, they must be discarded. 

• Do not touch RTE foods with bare hands, and minimize bare hand contact with exposed 

food that is not RTE. 

• Do not use a utensil more than once to taste food that is to be served or sold. 

• Wear clean clothes and hair restraints. 

• Do not work with exposed food if experiencing persistent sneezing, coughing, or a runny 

nose or discharge from eyes, nose, or mouth. 

• Eat and drink in designated areas to avoid the contamination of exposed food, food 

equipment, utensils, linen, and unwrapped single-service and single-use items or items 

that require protection. Drink from a closed beverage container, and handle the container 

properly to prevent the contamination of their hands and the container, exposed food, or 

other articles in the food establishment. 

Are there instances where a prospective employee should be denied 

employment in a food establishment serving an HSP? 

Yes. When a conditional job offer is made contingent on responses to questions or medical 

examinations that are designed to find out whether the individual has an illness that can be 

transmitted through food, and the prospective employee: 

• Has or reports symptoms such as vomiting, diarrhea, jaundice, or sore throat with fever, 

or has a lesion with pus, or has an uncovered open wound on hands, wrists, or 

on other body parts; 

• Reports a diagnosed illness contracted from Norovirus, hepatitis A virus, Shigella spp., 

E. coli O157:H7, Enterohemorrhagic or Shiga toxin-producing E. coli, Salmonella Typhi; 

or 

• Reports having a diagnosis of illness from Salmonella Typhi within the last 3 months 

without completing treatment prescribed by a health practitioner; 

• Has been exposed to, or implicated as, a suspected source by eating or preparing food 

associated with a confirmed disease outbreak; or 

• Reports a history of exposure that includes being in a setting of a confi rmed disease 

outbreak and living in the same household with someone who was in the area of a 

confirmed outbreak or who was diagnosed with an illness that was caused by a specific 

illness as previously described in the section. 

Under one or more of these circumstances, an individual should not be allowed to become a 

food employee until the applicable criteria as specified in section 2-201.13 of the 2005 Food Code 

are met. 

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PERSONAL HYGIENE 

What is effective handwashing? 

It is the act of cleansing hands by applying soap and water, rubbing them together vigorously, 

rinsing them with clean water, and thoroughly drying them. This process gets rid of dirt and germs. 

Every handwashing stage is important and effectively contributes to soil removal and reduction of 

microorganisms that can cause illness. 

Why is handwashing important? 

Handwashing reduces the spread of pathogenic microorganisms that are transmitted through 

food. The hands of food employees can be colonized with microorganisms such as Staphylococcus 

aureus or contaminated with organisms from human fecal material, such as Norovirus, Shigella 

spp., hepatitis A virus, E. coli O157:H7, or Salmonella Typhi, or contaminated from raw animal 

foods, with E. coli O157:H7 and Salmonella spp. These and other pathogenic microorganisms can 

get on the hands from a number of sources and then move from hands to food during preparation 

and service. 

An infected food employee and/or food employees with unclean hands, and exposed portions 

of arms or fingernails, can contaminate food. If a consumer eats contaminated food, foodborne 

illness may result. 

When should food employees wash their hands? 

They should do this immediately after engaging in activities that contaminate the hands and: 

•	 When entering a food preparation area; 

•	 Before putting on clean, single-use gloves for working with food and 

between glove changes;
 

•	 Before engaging in food preparation; 

•	 Before handling clean equipment and serving utensils; 

•	 When changing tasks and switching between handling raw foods and 

working with RTE foods;
 

•	 After handling soiled dishes, equipment, or utensils; 

•	 After touching bare human body parts, for example, parts other than 

clean hands and clean, exposed portions of arms;
 

•	 After using the toilet; 

•	 After coughing, sneezing, blowing the nose, using tobacco, eating, or drinking; and 

•	 After caring for or handling services animals or aquatic animals such as molluscan 

shellfish or crustacea in display tanks. 

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What handwashing steps do food employees need to follow? 

Clean hands and exposed portions of arms, including surrogate prosthetic devices for hands 

and arms, for at least 20 seconds by the following method: 

(1) Rinse under clean, warm running water; 

(2) Apply soap and rub all surfaces of the hands and fingers together vigorously with friction 

for at least 10 to 15 seconds, giving particular attention to the area under the fingernails, 

between the fingers/fingertips, and surfaces of the hands, arms, and surrogate 

prosthetic devices; 

(3) Rinse thoroughly with clean, warm running water; and 

(4) Thoroughly dry the hands and exposed portions of arms with single-use paper toweling, 

a heated-air hand-drying device, or a clean, unused towel from a continuous towel 

system that supplies the user with a clean towel. 

Avoid recontamination of hands and arms by using a clean barrier, such as a paper towel, 

when turning off hand sink faucets or touching the handle of a restroom door. 

It is important to follow these steps to remove germs from hands and ensure hands are as 

clean as possible. Thorough handwashing with warm water, the recommended amount of soap 

as indicated by the manufacturer, and proper hand drying are essential to reduce the possibility 

of hands transferring microorganisms to food. 

How important is the temperature of water used for handwashing? 

Warm water is generally more comfortable than cold water and encourages handwashing 

for the recommended duration. The water temperature used in handwashing can also affect the 

solubility or emulsification of some soils. Warm water is more effective than cold water in removing 

fatty soils. An adequate flow of warm water will cause soap to lather and aid in flushing soil quickly 

from the hands. The 2005 FDA Food Code specifies a minimum handwashing water temperature 

of 38o

C (100oF). 

How important is properly drying your hands after handwashing? 

Hand drying is a vital part of the handwashing process because thorough hand drying can 

provide an added reduction of microorganisms on the hands. The 2005 FDA Food Code lists 

three different effective methods. These include drying the hands with an air dryer and using a 

single-use towel or a clean, unused towel. 

Can hand antiseptics (hand sanitizers) be used in place of adequate handwashing 

in food establishments? 

No. Hand antiseptics should be used only in addition to proper handwashing. 

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What are some ways a food establishment can promote compliance 

with handwashing requirements? 

Train food employees on: 

•	 When to wash hands; 

•	 How to wash hands; and 

• Where to wash hands.
 

Stress the importance of:
 

•	 Following proper cleaning procedures; 

•	 Keeping hands and exposed portions of arms, including surrogate prosthetic devices 

for hands and arms, clean; 

• Keeping fi ngernails trimmed; 

•	 Washing hands only in designated handwashing sinks; and 

• Following the appropriate use of hand antiseptics. 

Managers are responsible for:
 

•	 Ensuring that food employees wash their hands, as required; 

•	 Providing accessible, properly maintained, designated handwashing sinks; 

•	 Making sure that handwashing sinks have clean, running warm water, soap and paper 

towels, or other approved means for drying; 

•	 Posting signage that notifies food employees of the handwashing requirement; and 

•	 Monitoring food employees to ensure proper handwashing and good hand hygiene 

protocol during the work shift. 

Tips for promoting effective handwashing practices in food establishments: 

•	 Make food employees aware of media coverage on local and national foodborne 

outbreaks. This awareness reinforces the reporting of symptoms, illness, and good 

handwashing procedures. 

•	 Create opportunities to remind food employees each week about the importance 

of hand hygiene. 

•	 Emphasize handwashing at the beginning of a shift, after using the toilet, after handling 

raw meat, and between changes of gloves. This emphasis will help keep good hand 

hygiene at the forefront. 

•	 Use a “buddy” system so that fellow food employees can support each other. 

•	 Use training and incentive programs to motivate food employees to take ownership and 

practice good personal hygiene habits. 

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An FDA study published in 2004 found food establishments were frequently out of compliance 

with the Food Code requirements for proper and adequate handwashing. In the study, the percent 

of food establishments observed to be out of compliance with handwashing requirements ranged 

from 34% in hospitals to 73% in full-service establishments. 

The following elements can impact handwashing compliance among food employees: 

• Make it a Priority: When management enforces handwashing compliance as a 

mandatory requirement, employees are more likely to follow the requirement. 

• Motivate: Provide motivation for handwashing, which has proven to have an impact on 

improving handwashing compliance. 

• Remove Deterrents: Conveniently located handwashing sinks have a huge impact on 

handwashing compliance. Studies have found that availability of handwashing sinks 

supplied with soap and running water has a big influence on compliance; however, 

materials and practices that cause irritation to the skin can decrease handwashing 

compliance. For example, excessive handwashing or use of harsh soaps can lead to 

skin irritation and subsequently decrease handwashing compliance. 

• Provide Positive Reinforcement: Rewards for compliance generally have a positive 

impact on improving handwashing compliance. 

Should food employees with one hand or those with a surrogate prosthetic 

device for hands and arms follow these handwashing procedures? 

Yes, this requirement for thorough handwashing is achievable through reasonable 

accommodation in accordance with the ADA. In order to achieve the intent of this requirement, 

devices are available that are attachable to a lavatory. These devices enable a one-handed food 

employee to generate the necessary friction to achieve the intent of this requirement. 

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NO BARE HAND CONTACT 

WITH READY-TO-EAT FOODS
 

When hands are heavily contaminated, effective handwashing practices may not be enough 

to prevent the transmission of transient pathogens from the hands to RTE foods. The 2005 FDA 

Food Code discourages bare hand contact with RTE food (i.e., food that is eaten without further 

washing or cooking) and requires the use of suitable utensils such as scoops, spoons, forks, 

spatulas, tongs, deli tissue, single-use gloves, or dispensing equipment when handling these food 

items. 

Bare hand contact with an RTE food, such as sandwiches and salads, can result in contamination 

of food and contribute to foodborne illness outbreaks. Therefore, food employees should always 

use suitable utensils such as spatulas, tongs, single-use gloves, or dispensing equipment when 

handling RTE foods. Single-use gloves used along with handwashing can be an effective barrier 

to decrease the transfer of microorganisms from the hand to food. However, gloves are not 

total barriers to microbial transmission, and will not be an effective barrier alone for food workers 

without education on proper glove use and handwashing requirements. 

Follow these instructions for the use of single-use gloves: 

•	 Always wash hands before donning gloves. 

•	 Change disposable gloves between handling raw products and RTE products. 

•	 Do not wash or reuse disposable gloves. 

•	 Discard torn or damaged disposable gloves. 

•	 Cover an infected lesion (cut, burn, or boil) with pus with a waterproof covering and 

disposable glove. 

•	 Wear disposable gloves over artificial nails, nail polish, or uncleanable orthopedic 

support devices. 

The 2005 FDA Food Code allows bare hand contact with RTE food only when the regulatory 

authority has granted prior approval for an alternative procedure. The alternative procedure must 

address the management of food employees and related food handling activities to prevent food 

contamination, including the enforcement of thorough handwashing practices after toilet use. 

Additional information on hand hygiene is available in the FDA/CFSAN Food Service Food 

Safety Fact Sheet entitled Hand Hygiene in Retail & Food Service Establishments, found at: 

http://vm.cfsan.fda.gov/~comm/handhyg.html 

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FORMS, TABLES, AND DECISION TREES*
 

FORMS 

Form 1-A Conditional Employee and Food Employee Interview 

Form 1-B Conditional Employee or Food Employee Reporting Agreement
 

Form 1-C Conditional Employee or Food Employee Medical Referral
 

Form 1-D Application for Bare Hand Contact Procedure 

TABLES 

2-201.12 

Table 1a: Summary of Requirements for Symptomatic Food Employees 

Table 1b: Summary of Requirements for Diagnosed, Symptomatic Food Employees 

Table 2: Summary of Requirements for Diagnosed Food Employees 

with Resolved Symptoms 

Table 3: Summary of Requirements for Diagnosed Food Employees 

Who Never Develop Gastrointestinal Symptoms 

Table 4: History of Exposure, and Absent Symptoms or Diagnosis 

DECISION TREES 

2-201.11 / 2-201.12 Decision Tree 1. 

When to Exclude or Restrict a Food Employee Who Reports a Symptom and 

When to Exclude a Food Employee Who Reports a Diagnosis with Symptoms 

Under the Food Code 

2-201.11 / 2-201.12 Decision Tree 2. 

When to Exclude or Restrict a Food Employee Who is Asymptomatic and Reports 

a Listed Diagnosis and When to Restrict a Food Employee Who Reports a Listed 

Exposure Under the Food Code 

* Note: Editorial changes made to the forms, tables, and decision trees on the following pages were for clarity only. 

No substantive changes were made, and parallel editorial changes are planned for the 2009 FDA Food Code. 

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FORM 1-A Conditional Employee and Food Employee Interview 

Preventing Transmission of Diseases through Food by Infected Food Employees 

or Conditional Employees with Emphasis on Illness due to Norovirus, Salmonella 

Typhi (S. Typhi), Shigella spp., Enterohemorrhagic (EHEC) or Shiga Toxin-producing 

Escherichia coli (STEC), or Hepatitis A Virus 

The purpose of this interview is to inform conditional employees and food employees 

to advise the person in charge of past and current conditions described so that the person 

in charge can take appropriate steps to preclude the transmission of foodborne illness. 

Conditional Employee Name (print) ______________________________________________ 

Food Employee Name (print) ___________________________________________________ 

Address ____________________________________________________________________ 

Telephone – Daytime: ________________________ Evening: ________________________ 

Date ______________________________________ 

Are you suffering from any of the following symptoms? (Circle one)

 If YES, Date of Onset

Diarrhea? YES / NO __________________

Vomiting? YES / NO __________________

Jaundice? YES / NO __________________ 

Sore throat with fever? YES / NO __________________

 Or 

Infected cut or wound that is open and draining, or lesions containing pus on the hand, 

wrist, an exposed body part, or other body part and the cut, wound, or lesion not properly 

covered?

 YES / NO (Examples: boils and infected wounds, however small) 

In the Past: 

Have you ever been diagnosed as being ill with typhoid fever (S. Typhi) YES / NO 

If you have, what was the date of the diagnosis? __________________________________ 

If within the past 3 months, did you take antibiotics for S. Typhi? YES / NO 

If so, how many days did you take the antibiotics? ___________________________ 

If you took antibiotics, did you finish the prescription? ______________ YES / NO 

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FORM 1-A (continued) 

History of Exposure: 

1. Have you been suspected of causing, or have you been exposed 

to, a confirmed foodborne disease outbreak recently? YES / NO 

 If YES, date of outbreak: ____________________________________________ 

a. If YES, what was the cause of the illness and did it meet the following criteria? 

Cause: _______________________________________________________________ 

 i. Norovirus (last exposure within the past 48 hours) 

 Date of illness outbreak __________ 

 ii. E. coli O157:H7 infection (last exposure within the past 3 days) 

 Date of illness outbreak __________ 

 iii. Hepatitis A virus (last exposure within the past 30 days) 

 Date of illness outbreak __________ 

 iv. Typhoid fever (last exposure within the past 14 days) 

 Date of illness outbreak __________ 

 v. Shigellosis (last exposure within the past 3 days) 

 Date of illness outbreak __________ 

b. If YES, did you: 

i. Consume food implicated in the outbreak? _______________________________ 

ii. Work in a food establishment that was the source of the outbreak? ___________ 

iii. Consume food at an event that was prepared by person who is ill? ___________ 

2. Did you attend an event or work in a setting recently where there 

was a confirmed disease outbreak? YES / NO 

 If so, what was the cause of the confirmed disease outbreak? _____________ 

__________________________________________________________________ 

If the cause was one of the following fi ve pathogens, 

did exposure to the pathogen meet the following criteria? 

a. Norovirus (last exposure within the past 48 hours) YES / NO

 b. E. coli O157:H7 (or other EHEC/STEC) 

(last exposure within the past 3 days) YES / NO 

c. Shigella spp. (last exposure within the past 3 days) YES / NO

 d. S. Typhi (last exposure within the past 14 days) YES / NO 

e. Hepatitis A virus (last exposure within the past 30 days) YES / NO 

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FORM 1-A (continued) 

Do you live in the same household as a person diagnosed with Norovirus, 

shigellosis, typhoid fever, hepatitis A, or illness due to E. coli O157:H7 or 

other EHEC/STEC? 

 YES / NO Date of onset of illness ______________ 

3. Do you have a household member attending or working in a setting where there is 

a confirmed disease outbreak of Norovirus, typhoid fever, shigellosis, EHEC/STEC 

infection, or hepatitis A? 

 YES / NO Date of onset of illness ______________ 

Name, Address, and Telephone Number of your Health Practitioner or Doctor: 

Name __________________________________________________________________ 

Address ________________________________________________________________ 

Telephone – Daytime:______________________ Evening: _______________________ 

Signature of Conditional Employee ________________________________ Date ________ 

Signature of Food Employee ______________________________________ Date ________ 

Signature of Permit Holder or Representative ________________________ Date ________ 

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FORM 1-B Conditional Employee or Food Employee Reporting Agreement 

Preventing Transmission of Diseases through Food by Infected Conditional Employees 

or Food Employees with Emphasis on Illness due to Norovirus, Salmonella Typhi, 

Shigella spp., Enterohemorrhagic (EHEC) or Shiga Toxin-producing Escherichia coli 

(STEC), or Hepatitis A Virus 

The purpose of this agreement is to inform conditional employees or food employees 

of their responsibility to notify the person in charge when they experience any of the 

conditions listed so that the person in charge can take appropriate steps to preclude the 

transmission of foodborne illness. 

I AGREE TO REPORT TO THE PERSON IN CHARGE: 

Any Onset of the Following Symptoms, While Either at Work or Outside of Work, Including 

the Date of Onset: 

1. Diarrhea 

2. Vomiting 

3. Jaundice 

4. Sore throat with fever 

5. Infected cuts or wounds, or lesions containing pus on the hand, wrist, an exposed body 

part, or other body part and the cuts, wounds, or lesions are not properly covered (such 

as boils and infected wounds, however small) 

Future Medical Diagnosis: 

Whenever diagnosed as being ill with Norovirus, typhoid fever (Salmonella Typhi), 

shigellosis (Shigella spp. infection), Escherichia coli O157:H7 or other EHEC/STEC infection, 

or hepatitis A (hepatitis A virus infection) 

Future Exposure to Foodborne Pathogens: 

1. Exposure to or suspicion of causing any confirmed disease outbreak of 

Norovirus, typhoid fever, shigellosis, E. coli O157:H7 or other EHEC/STEC 

infection, or hepatitis A.
 

2. A household member diagnosed with Norovirus, typhoid fever, shigellosis, illness 

due to EHEC/STEC, or hepatitis A. 

3. A household member attending or working in a setting experiencing a confirmed 

disease outbreak of Norovirus, typhoid fever, shigellosis, E. coli O157:H7 or other 

EHEC/STEC infection, or hepatitis A. 

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FORM 1-B (continued) 

I have read (or had explained to me) and understand the requirements concerning my responsibilities 

under the Food Code and this agreement to comply with: 

1. Reporting requirements specified above involving symptoms, 

diagnoses, and exposure specified; 

2. Work restrictions or exclusions that are imposed upon me; and 

3. Good hygienic practices. 

I understand that failure to comply with the terms of this agreement could lead to action by the 

food establishment or the food regulatory authority that may jeopardize my employment and may 

involve legal action against me. 

Conditional Employee Name (please print) ________________________________________ 

Signature of Conditional Employee ________________________________ Date _________ 

Food Employee Name (please print) _____________________________________________ 

Signature of Food Employee _____________________________________ Date _________ 

Signature of Permit Holder or Representative _______________________ Date _________ 

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_____________________________________________________________________ 

 

FORM 1-C Conditional Employee or Food Employee Medical Referral 

Preventing Transmission of Diseases through Food by Infected Food Employees with 

Emphasis on Illness due to Norovirus, Typhoid Fever (Salmonella Typhi), Shigellosis 

(Shigella spp.), Escherichia coli O157:H7 or other Enterohemorrhagic (EHEC) or 

Shiga Toxin-producing Escherichia coli (STEC), and Hepatitis A Virus 

The Food Code specifi es, under Part 2-2 Employee Health Subpart 2-201 Disease or 

Medical Condition, that Conditional Employees and Food Employees obtain medical clearance 

from a health practitioner licensed to practice medicine, unless the Food Employees have complied 

with the provisions specified as an alternative to providing medical documentation, whenever the 

individual: 

1. Is chronically suffering from a symptom such as diarrhea; or 

2. Has a current illness involving Norovirus, typhoid fever (Salmonella Typhi), shigellosis 

(Shigella spp.), E. coli O157:H7 infection (or other EHEC/STEC), or hepatitis A virus 

(hepatitis A), or 

3. Reports past illness involving typhoid fever (S. Typhi) within the past 3 months (while 

salmonellosis is fairly common in the United States, typhoid fever, caused by infection 

with S. Typhi, is rare). 

Conditional employee being referred: (Name, please print) ___________________________ 

Food Employee being referred: (Name, please print) ________________________________ 

4. Is the employee assigned to a food establishment that serves a population that meets 

the Food Code definition of a highly susceptible population such as a day care center 

with preschool-age children, a hospital kitchen with immunocompromised persons, or an 

assisted living facility or nursing home with older adults? YES NO 

Reason for Medical Referral: The reason for this referral is checked below: 

Is chronically suffering from vomiting or diarrhea; or (specify) ______________________
 

Diagnosed or suspected Norovirus, typhoid fever, shigellosis, E. coli O157:H7 (or other 

EHEC/STEC) infection, or hepatitis A. (Specify) ________________________________
 

Reported past illness from typhoid fever within the past 3 months. 

(Date of illness) _________________________________________________________
 

Other medical condition of concern per the following description: __________________ 

39 
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FORM 1-C (continued) 

Health Practitioner’s Conclusion: (Circle the appropriate one; refer to reverse side of form) 

 Food employee is free of Norovirus infection, typhoid fever (S. Typhi infection), 

Shigella spp. infection, E. coli O157:H7 (or other EHEC/STEC infection), or hepatitis A 

virus infection, and may work as a food employee without restrictions. 

 Food employee is an asymptomatic shedder of E. coli O157:H7 (or other EHEC/STEC), 

Shigella spp., or Norovirus, and is restricted from working with exposed food; clean 

equipment, utensils, and linens; and unwrapped single-service and single-use articles in 

food establishments that do not serve highly susceptible populations. 

 Food employee is not ill but continues as an asymptomatic shedder of E. coli 

O157:H7 (or other EHEC/STEC) and Shigella spp. and should be excluded from 

food establishments that serve highly susceptible populations such as those who are 

preschool age, immunocompromised, or older adults and in a facility that provides 

preschool custodial care, health care, or assisted living. 

Food employee is an asymptomatic shedder of hepatitis A virus and should be 

excluded from working in a food establishment until medically cleared. 

Food employee is an asymptomatic shedder of Norovirus and should be excluded from 

working in a food establishment until medically cleared, or for at least 24 hours from the 

date of the diagnosis. 

Food employee is suffering from Norovirus, typhoid fever, shigellosis, E. coli O157:H7 

(or other EHEC/STEC infection), or hepatitis A and should be excluded from working in 

a food establishment. 

COMMENTS: (In accordance with Title I of the Americans with Disabilities Act (ADA) and to 

provide only the information necessary to assist the food establishment operator in preventing 

foodborne disease transmission, please confine comments to explaining your conclusion and 

estimating when the employee may be reinstated.) 

____________________________________________________________________________ 

____________________________________________________________________________ 

____________________________________________________________________________ 

____________________________________________________________________________ 

____________________________________________________________________________ 

____________________________________________________________________________ 

Signature of Health Practitioner ____________________________ Date ________________ 

40 
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______________________________________________________________________ 

______________________________________________________________________ 

 

FORM 1-D Application for Bare Hand Contact Procedure

 (As specified in Food Code ¶ 3-301.11(D)) 

Please type or print legibly using black or blue ink 

1. Establishment Name: ___________________________________________________ 

2. Establishment Address: _________________________________________________ 

3. Responsible Person: __________________________________ Phone: ___________ 

Legal Representative 

Business
 

4. List Procedure and Specific Ready-to-Eat Foods to be considered for use of bare 

hand contact with ready-to-eat foods: ________________________________________ 

5. Handwashing Facilities: 

 (a) There is a handwashing sink located immediately adjacent to the posted bare hand 

contact procedure, and the hand sink is maintained in accordance with provisions of the 

Code (§ 5-205.11, § 6-301.11, § 6-301.12, and § 6-301.14). YES NO 

(Include diagram, photo, or other information) 

 (b) All toilet rooms have one or more handwashing sinks in, or immediately adjacent to, 

them, and the sinks are equipped and maintained in accordance with provisions of the 

Code (§ 5-205.11, § 6-301.11, § 6-301.12, and § 6-301.14). YES NO 

6. Employee Health Policy: The written employee health policy must be attached to 

this form along with documentation that food employees and conditional employees 

acknowledge their responsibilities (§ 2-201.11, § 2-201.12, and § 2-201.13). 

7. Employee Training: Provide documentation that food employees have received training in: 

• The risks of contacting the specific ready-to-eat foods with bare hands; 

•	 Personal health and activities as they relate to diseases that are transmissible 

through food; 

•	 Proper handwashing procedures to include how, when, where to wash, 

and fingernail maintenance (§ 2-301.12, § 2-301.14, § 2-301.15, and § 2-302.11); 

• Prohibition of jewelry (§ 2-303.11); and 

• Good hygienic practices (§ 2-401.11 and § 2-401.12). 

8. Documentation of Handwashing Practices: Provide documentation that food 

employees are following proper handwashing procedures prior to food preparation 

and other procedures as necessary to prevent cross-contamination during all hours of 

operation when the specific ready-to-eat foods are prepared or touched with bare hands. 

41 
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FORM 1-D (continued) 

9. Documentation of Additional Control Measures: Provide documentation to 

demonstrate that food employees are utilizing two or more of the following control 

measures when contacting ready-to-eat foods with bare hands: 

• Double handwashing; 

• Use of nail brushes; 

• Use of hand antiseptic after handwashing; 

• Incentive programs such as paid leave encouraging food 

employees not to work when they are ill; or 

• Other control measures approved by the regulatory authority. 

Statement of Compliance: 

I certify all of the following: All food employees are individually trained in the risks of contacting 

ready-to-eat foods with bare hands, personal health and activities as they relate to diseases that 

are transmissible through food, proper handwashing procedures, prohibition of jewelry, and good 

hygienic practices. A record of this training is kept on site. I understand that bare hand contact 

with ready-to-eat food is prohibited except for those items listed in section four (4) above. A 

handwashing sink is located immediately adjacent to the posted bare hand contact procedure. 

All handwashing sinks are maintained with hot water, soap, and drying devices. I understand 

that documentation is needed for handwashing practices and additional control measures. I 

understand that records to document handwashing are kept current and kept on site. 

SIGNATURE:________________________________________ DATE: ___________________ 

(Signature of legal representative of the facility listed above) 

Regulatory Authority (RA) Use Only: 

Permit Number: ______________________________________________________________ 

File Review Conducted on History of Handwashing Compliance: Yes No 

Site Visit Conducted: Yes No Comments: ___________________________________ 

Approved: Effective Date: _________________ RA Name: __________________________

 Not Approved: Reason for Denial: ______________________________________________ 

42 
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2-201.12 Table 1a: Summary of Requirements for Symptomatic Food Employees 

Food employees and conditional employees shall report 

symptoms immediately to the person in charge 

The person in charge shall prohibit a conditional employee who reports a listed symptom from 

becoming a food employee until meeting the criteria listed in section 2-201.13 of the Food 

Code, for reinstatement of a symptomatic food employee. 

Symptom 

EXCLUSION OR RESTRICTION Removing Symptomatic 

Food Employees from 

Exclusion or Restriction 

RA 

Approval 

Needed to 

Return to 

Work? 

Facilities 

Serving an HSP 

Facilities Not 

Serving an HSP 

Vomiting EXCLUDE 

2-201.12(A)(1) 

EXCLUDE 

2-201.12(A)(1) 

When the excluded food 

employee has been asymptomatic for at least 24 hours 

or provides medical documentation 2-201.13(A)(1). 

Exceptions: If diagnosed 

with Norovirus, Shigella 

spp., E. coli O157:H7 or 

other EHEC/STEC, HAV, or 

typhoid fever (S. Typhi) 

(see Tables 1b & 2). 

No if not 

diagnosed 

Diarrhea EXCLUDE 

2-201.12(A)(1) 

EXCLUDE 

2-201.12(A)(1) 

When the excluded food 

employee has been asymptomatic for at least 24 hours 

or provides medical documentation 2-201.13(A). 

Exceptions: If diagnosed 

with Norovirus, E. coli 

O157:H7 or other EHEC/ 

STEC, HAV, or S. Typhi 

(see Tables 1b & 2). 

No if not 

diagnosed 

Jaundice EXCLUDE 

2-201.12(B)(1) 

if the onset 

occurred within 

the last 7 days 

EXCLUDE 

2-201.12(B)(1) 

if the onset 

occurred within 

the last 7 days 

When approval is obtained 

from the RA 2-201.13(B), 

and: 

• Food employee has been 

jaundiced for more than 

7 calendar days 2-201.13 

(B)(1), or 

• Food employee provides 

medical documentation 

2-201.13(B)(3). 

Yes 

(continued) 43 
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2-201.12 Table 1a: Summary of Requirements for Symptomatic Food Employees

 (continued) 

Symptom 

EXCLUSION OR RESTRICTION 

Removing Symptomatic 

Food Employees from 

Exclusion or Restriction 

RA 

Approval 

Needed to 

Return to 

Work? 

Facilities 

Serving an HSP 

Facilities Not 

Serving an HSP 

Sore 

throat with

fever 

EXCLUDE 

2-201.12(G)(1) 

RESTRICT 

2-201.12(G)(2) 

When food employee 

provides written medical 

documentation 2-201.13(G)

(1)-(3). 

No 

Infected 

wound or 

pustular 

boil 

RESTRICT 

2-201.12(H) 

RESTRICT 

2-201.12(H) 

When the infected wound 

or boil is properly covered 

2-201.13(H)(1)-(3). 

No 

 

Key for Table 1a: 

HSP = Highly Susceptible Population 

RA = Regulatory Authority 

EHEC/STEC = Enterohemorrhagic or Shiga Toxin-producing Escherichia coli 

HAV = Hepatitis A Virus 

44 
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2-201.12 Table 1b: Summary of Requirements for Diagnosed, Symptomatic 

Food Employees 

Food employees and conditional employees shall report a listed 

diagnosis with symptoms immediately to the person in charge 

The person in charge shall notify the RA when a food employee 

is jaundiced or reports a listed diagnosis 

The person in charge shall prohibit a conditional employee who reports a listed diagnosis with 

symptoms from becoming a food employee until meeting the criteria listed in section 

2-201.13 of the Food Code, for reinstatement of a diagnosed, symptomatic food employee. 

Diagnosis 

EXCLUSION 

Facilities Serving 

an HSP or Not 

Serving an HSP 

Removing Diagnosed, 

Symptomatic Food Employees 

from Exclusion 

RA Approval 

Needed to 

Return to Work? 

Hepatitis A 

virus 

EXCLUDE if within 14 

days of any symptom, 

or within 7 days of 

jaundice 

2-201.12(B)(2) 

When approval is obtained from the 

RA 2-201.13(B), and: 

• The food employee has been 

jaundiced for more than 7 calendar 

days 2-201.13(B)(1), or 

• The anicteric food employee has 

had symptoms for more than 

14 days 2-201.13(B)(2), or 

• The food employee provides 

medical documentation 2-201.13 

(B)(3) (also see Table 2). 

Yes 

Typhoid 

fever 

(S. Typhi) 

EXCLUDE 

2-201.12(C) 

When approval is obtained from the 

RA 2-201.13(C)(1), and: 

• Food employee provides medical 

documentation that states the food 

employee is free of an S. Typhi 

infection 2-201.13(C)(2) 

(also see Table 2). 

Yes 

(continued) 45 
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1/12/09 9:46 

2-201.12 Table 1b: Summary of Requirements for Diagnosed, Symptomatic 

Food Employees (continued) 

Diagnosis 

EXCLUSION 

Facilities Serving 

an HSP or Not 

Serving an HSP 

Removing Diagnosed, 

Symptomatic Food Employees 

from Exclusion 

RA Approval 

Needed to 

Return to Work? 

E. coli 

O157:H7 

or other 

EHEC/ 

STEC 

EXCLUDE 

Based on vomiting or 

diarrhea symptoms, 

under 2-201.12(A)(2) 

1. Serving a non-HSP facility: 

2-201.13(A)(4)(a): Shall only 

work on a restricted basis 24 

hours after symptoms resolve and 

remains restricted until meeting the 

requirements listed below: 

2. Serving an HSP facility: 

2-201.13(A)(4)(b): Remains 

excluded until meeting the 

requirements listed below: 

• Approval is obtained from the RA 

2-201.13(F), and 

• Medically cleared 2-201.13(F)(1), 

or 

• More than 7 calendar days have 

passed since the food employee 

became asymptomatic 2-201.13 

(F)(2) (also see Table 2). 

Yes to return 

to an HSP 

or to return 

unrestricted; not 

required to work 

on a restricted 

basis in a nonHSP facility 

Norovirus EXCLUDE 

Based on vomiting or 

diarrhea symptoms, 

under 2-201.12(A)(2) 

1. Serving a non-HSP facility: 

2-201.13 (A)(2)(a): Shall only 

work on a restricted basis 24 

hours after symptoms resolve and 

remains restricted until meeting the 

requirements listed below: 

2. Serving an HSP facility: 

2-201.13(A)(2)(b): Remains 

excluded until meeting the 

requirements listed below: 

• Approval is obtained from the RA 

2-201.13(D), and 

• Medically cleared 2-201.13(D)(1), 

or 

• More than 48 hours have passed 

since the food employee became 

asymptomatic 2-201.13(D)(2) 

(also see Table 2). 

Yes to return 

to an HSP 

or to return 

unrestricted; not 

required to work 

on a restricted 

basis in a nonHSP facility 

(continued) 46 
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1/12/09 9:46 

2-201.12 Table 1b: Summary of Requirements for Diagnosed, Symptomatic 

Food Employees (continued) 

Diagnosis 

EXCLUSION 

Facilities Serving 

an HSP or Not 

Serving an HSP 

Removing Diagnosed, 

Symptomatic Food Employees 

from Exclusion 

RA Approval 

Needed to 

Return to Work? 

Shigella 

spp. 

EXCLUDE 

Based on vomiting or 

diarrhea symptoms, 

under 2-201.12(A)(2) 

1. Serving a non-HSP facility: 

2-201.13(A)(3)(a): Shall only 

work on a restricted basis 24 

hours after symptoms resolve and 

remains restricted until meeting the 

requirements listed below: 

2. Serving an HSP facility: 

2-201.13(A)(3)(b): Remains 

excluded until meeting the 

requirements listed below: 

• Approval is obtained from the RA 

2-201.13(E), and 

• Medically cleared 2-201.13(E)(1), 

or 

• More than 7 calendar days 

have passed since the food 

employee became asymptomatic 

2-201.13(E)(2) (also see Table 2). 

Yes to return 

to an HSP 

or to return 

unrestricted; not 

required to work 

on a restricted 

basis in a nonHSP facility 

Key for Table 1b: 

RA = Regulatory Authority 

HSP = Highly Susceptible Population 

EHEC/STEC = Enterohemorrhagic or Shiga Toxin-producing Escherichia coli 

47 
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1/12/09 9:46 

48 
81082_EH&HygieneHandbook.indd Sec1:49 81082_EH&HygieneHandbook.indd Sec1:49 1/12/09 9:46

1/12/09 9:46 

2-201.12 Table 2: Summary of Requirements for Diagnosed Food Employees 

with Resolved Symptoms 

Food employees and conditional employees shall report 

a listed diagnosis immediately to the person in charge 

The person in charge shall notify the RA when a food employee reports a listed diagnosis 

The person in charge shall prohibit a conditional employee who reports a listed diagnosis from 

becoming a food employee until meeting the criteria listed in section 2-201.13 of the Food Code, 

for reinstatement of a diagnosed food employee. 

Pathogen 

Diagnosis 

Facilities 

Serving an 

HSP 

Facilities 

Not Serving 

an HSP 

Removing Diagnosed Food 

Employees with Resolved 

Symptoms from Exclusion 

or Restriction 

RA Approval 

Required 

to Return 

to Work? 

Typhoid fever 

(S. Typhi) 

including previous illness with 

S. Typhi (see 

2-201.11(A)(3)) 

EXCLUDE 

2-201.12(C) 

EXCLUDE 

2-201.12(C) 

When approval is obtained 

from the RA 2-201.13(C)(1), 

and: 

• Food employee provides 

medical documentation that 

states the food employee is 

free of an S. Typhi infection 

2-201.13)(C)(2) (also see 

Table 1b). 

Yes 

Shigella spp. EXCLUDE 

2-201.12(E)(1) 

RESTRICT 

2-201.12(E)(2) 

1. Serving a non-HSP facility: 

2-201.13(A)(3)(a): Shall only 

work on a restricted basis 24 

hours after symptoms resolve 

and remains restricted until 

meeting the requirements 

listed below: 

2. Serving an HSP facility: 

2-201.13(A)(3)(b): Remains 

excluded until meeting the 

requirements listed below: 

• Approval is obtained from the 

RA 2-201.13(E), and 

• Medically cleared 2-201.13 

(E)(1), or 

• More than 7 calendar days 

have passed since the 

food employee became 

asymptomatic 2-201.13(E)(3) 

(a) (also see Table 1b). 

Yes to return 

to an HSP or 

to return unrestricted; not 

required to work 

on a restricted 

basis in a nonHSP facility 

(continued) 49 
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2-201.12 Table 2: Summary of Requirements for Diagnosed Food Employees 

with Resolved Symptoms (continued) 

Pathogen 

Diagnosis 

Facilities 

Serving an 

HSP 

Facilities 

Not Serving 

an HSP 

Removing Diagnosed Food 

Employees with Resolved 

Symptoms from Exclusion 

or Restriction 

RA Approval

Required 

to Return 

to Work? 

Norovirus EXCLUDE 

2-201.12(D)(1) 

RESTRICT 

2-201.12(D)(2) 

1. Serving a non-HSP facility: 

2-201.13(A)(2)(a): Shall only 

work on a restricted basis 24 

hours after symptoms resolve 

and remains restricted until 

meeting the requirements 

listed below: 

2. Serving an HSP facility: 

2-201.13(A)(2)(b): Remains 

excluded until meeting the 

requirements listed below: 

• Approval is obtained from the 

RA 2-201.13(D), and 

• Medically cleared 

2-201.13(D)(1), or 

• More than 48 hours 

have passed since the 

food employee became 

asymptomatic 2-201.13(D)(2) 

(also see Table 1b). 

Yes to return 

to an HSP or 

to return unrestricted; not 

required to work 

on a restricted 

basis in a nonHSP facility 

 

(continued) 50 
81082_EH&HygieneHandbook.indd Sec1:51 81082_EH&HygieneHandbook.indd Sec1:51 1/12/09 9:46

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2-201.12 Table 2: Summary of Requirements for Diagnosed Food Employees 

with Resolved Symptoms (continued) 

Pathogen 

Diagnosis 

Facilities 

Serving an 

HSP 

Facilities 

Not Serving 

an HSP 

Removing Diagnosed Food 

Employees with Resolved 

Symptoms from Exclusion 

or Restriction 

RA Approval 

Required 

to Return 

to Work? 

E. coli 

O157:H7 or 

other EHEC/ 

STEC 

EXCLUDE 

2-201.12(F)(1) 

RESTRICT 

2-201.12(F)(2)

1. Serving a non-HSP facility: 

2-201.13(A)(4)(a): Shall only 

work on a restricted basis 24 

hours after symptoms resolve 

and remains restricted until 

meeting the requirements 

listed below: 

2. Serving an HSP facility: 

2-201.13(A)(4)(b): Remains 

excluded until meeting the 

requirements listed below: 

• Approval is obtained from th

RA 2-201.13(F), and 

• Medically cleared 

2-201.13(F)(1), or 

• More than 7 calendar days 

have passed since the 

food employee became 

asymptomatic 2-201.13(F)(2). 

e

Yes to return 

to an HSP or 

to return unrestricted; not 

required to work 

on a restricted 

basis in a nonHSP facility 

Hepatitis A 

virus 

EXCLUDE 

If within 14 

days of any 

symptom, or 

within 7 days 

of jaundice 

2-201.12(B)(2) 

EXCLUDE 

If within 14 

days of any 

symptom, or 

within 7 days 

of jaundice 

2-201.12(B)(2) 

When approval is obtained 

from the RA 2-201.13(B), and: 

• The food employee has bee

jaundiced for more than 

7 calendar days 2-201.13(B) 

(1), or 

• The anicteric food employee 

has had symptoms for more 

than 14 days 2-201.13(B) 

(2), or 

• The food employee provides 

medical documentation 

2-201.13(B)(3) (see also 

Table 1b). 

n 

Yes 

 

Key for Table 2: 

RA = Regulatory Authority 

HSP = Highly Susceptible Population 

EHEC/STEC = Enterohemorrhagic or Shiga Toxin-producing Escherichia coli 51 
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1/12/09 9:46 

52 
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1/12/09 9:46 

2-201.12 Table 3: Summary of Requirements for Diagnosed Food Employees Who 

Never Develop Gastrointestinal Symptoms 

Food employees and conditional employees shall report 

a listed diagnosis immediately to the person in charge 

The person in charge shall notify the RA when a food employee reports a listed diagnosis 

The person in charge shall prohibit a conditional employee who reports a listed diagnosis from 

becoming a food employee until meeting the criteria listed in section 2-201.13 of the Food Code, 

for reinstatement of a diagnosed food employee. 

Pathogen 

Diagnosis 

Facilities 

Serving an 

HSP 

Facilities 

Not Serving 

an HSP 

Removing Diagnosed Food 

Employees Who Never 

Develop Gastrointestinal 

ymptoms from Exclusion or 

Restriction 

S

RA Approval 

Required 

to Return 

to Work? 

Typhoid 

fever (S. 

Typhi) 

including 

previous illness with S. 

Typhi (see 

2-201.11(A) 

(3)) 

EXCLUDE 

2-201.12(C) 

EXCLUDE 

2-201.12(C) 

When approval is obtained from 

the RA 2-201.13(C)(1), and: 

• Food employee provides 

medical documentation, 

specifying that the food 

employee is free of an S. 

Typhi infection 2-201.13(C) 

(2). 

Yes 

Shigella 

spp. 

EXCLUDE 

2-201.12(E)(1) 

RESTRICT 

2-201.12(E)(2) 

Remains excluded or restricted 

until approval is obtained from 

the RA, and: 

• Medically cleared 2-201.13(E) 

(1), or 

• More than 7 calendar days 

have passed since the food 

employee was last diagnosed 

2-201.13(E)(3). 

Yes to return 

to an HSP or 

to return unrestricted; not 

required to work 

on a restricted 

basis in a nonHSP facility 

Norovirus EXCLUDE 

2-201.12(D)(1)

RESTRICT 

2-201.12(D)(2)

Remains excluded or restricted 

until approval is obtained from 

the RA 2-201.13(D), and 

• Medically cleared 2-201.13(D)

(1), or 

• More than 48 hours have 

passed since the food 

employee was diagnosed 

2-201.13(D)(3). 

Yes to return 

to an HSP or 

to return unrestricted; not 

required to work 

on a restricted 

basis in a nonHSP facility 

(continued) 53 
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2-201.12 Table 3: Summary of Requirements for Diagnosed Food Employees Who 

Never Develop Gastrointestinal Symptoms (continued) 

Pathogen 

Diagnosis 

Facilities 

Serving an 

HSP 

Facilities 

Not Serving 

an HSP 

Removing Diagnosed Food 

Employees Who Never 

Develop Gastrointestinal 

Symptoms from Exclusion or 

Restriction 

RA Approval 

Required 

to Return 

to Work? 

E. coli 

O157:H7 or 

other EHEC/ 

STEC 

EXCLUDE 

2-201.12(F)(1) 

RESTRICT 

2-201.12(F)(2)

Remains excluded or restricted 

until approval is obtained from 

the RA 2-201.13(F), and: 

• Medically cleared 2-201.13(F)

(1), or 

• More than 7 calendar days 

have passed since the food 

employee was diagnosed 

2-201.13(F)(3). 

Yes to return 

to an HSP or 

to return unrestricted; not 

required to work 

on a restricted 

basis in a nonHSP facility 

Hepatitis A 

virus 

EXCLUDE 

2-201.12(B)(3) 

EXCLUDE 

2-201.12(B)(3) 

When approval is obtained from

the RA 2-201.13(B), and 

• The anicteric food employee 

has had symptoms for more 

than 14 days 2-201.13(B)(2), 

or 

• The food employee provides 

medical documentation 

2-201.13(B)(3). 

Yes 

 

Key for Table 3: 

RA = Regulatory Authority 

HSP = Highly Susceptible Population 

EHEC/STEC = Enterohemorrhagic or Shiga Toxin-producing Escherichia coli 

54 
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2-201.12 Table 4: History of Exposure, and Absent Symptoms or Diagnosis 

Food employees and conditional employees shall report 

a listed exposure to the person in charge 

The person in charge shall prohibit a conditional employee who reports 

a listed exposure from becoming a food employee in a facility serving an HSP 

until meeting the criteria listed in section 2-201.13 of the Food Code, 

for reinstatement of an exposed food employee 

The person in charge shall reinforce and ensure compliance with good hygienic practices, 

symptom reporting requirements, proper handwashing, and no BHC with RTE foods for all 

food employees that report a listed exposure. 

Pathogen 

Diagnosis 

Facilities 

Serving an 

HSP 

Facilities Not 

Serving an HSP 

When Can the Restricted 

Food Employee Return 

to Work? 

RA 

Approval 

Needed? 

Typhoid 

fever (S. 

Typhi) 

RESTRICT 

2-201.12(I) 

Educate food employee on symptoms

to watch for and 

ensure compliance with GHP, 

handwashing, and 

no BHC with RTE 

foods. 

2-201.13(I)(3) 

When 14 calendar days 

have passed since the 

last exposure, or more 

than 14 days have passed 

since the food employee’s 

household contact became 

asymptomatic. 

No 

Shigella 

spp. 

RESTRICT 

2-201.12(I) 

Educate food employee on symptom

to watch for and 

ensure compliance with GHP, 

handwashing, and 

no BHC with RTE 

foods. 

2-201.13(I)(2) 

When more than 3 calendar days have passed 

since the last exposure, 

or more than 3 days have 

passed since the food employee’s household contact

became asymptomatic. 

No 

s 

Norovirus RESTRICT 

2-201.12(I) 

Educate food employee on symptoms

to watch for and 

ensure compliance with GHP, 

handwashing, and 

no BHC with RTE 

foods. 

2-201.13(I)(1) 

When more than 48 hours 

have passed since the last 

exposure, or more than 

48 hours have passed 

since the food employee’s 

household contact became 

asymptomatic. 

No 

(continued) 55 
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2-201.12 Table 4: History of Exposure, and Absent Symptoms or Diagnosis

 (continued) 

Pathogen 

Diagnosis 

Facilities 

Serving an 

HSP 

Facilities Not 

Serving an HSP 

When Can the Restricted 

Food Employee Return 

to Work? 

RA 

Approval 

Needed? 

E. coli 

O157:H7 or 

other EHEC/ 

STEC 

RESTRICT 

2-201.12(I) 

Educate food employee on symptoms

to watch for and 

ensure compliance with GHP, 

handwashing, and 

no BHC with RTE 

foods. 

2-201.13(I)(2) 

When more than 3 calendar days have passed 

since the last exposure, 

or more than 3 calendar 

days have passed since 

the food employee’s 

household contact became 

asymptomatic. 

No 

Hepatitis A 

virus 

RESTRICT 

2-201.12(I) 

Educate food employee on symptoms

to watch for and 

ensure compliance with GHP, 

handwashing, and 

no BHC with RTE 

foods. 

2-201.13(I)(4) 

When any of the following 

conditions is met: 

• The food employee is 

immune to HAV infection 

because of a prior illness 

from HAV, vaccination 

against HAV, or IgG 

administration; or 

• More than 30 calendar 

days have passed 

since the last exposure, 

or since the food 

employee’s household 

contact became 

jaundiced; or 

• The food employee does 

not use an alternative 

procedure that allows 

BHC with RTE food until 

at least 30 days after the 

potential exposure, and 

the employee receives 

additional training. 

No 

 

Key for Table 4: 

HSP = Highly Susceptible Population; BHC = Bare Hand Contact; RTE = Ready-to-Eat; 

RA = Regulatory Authority; GHP = Good Hygienic Practices; and EHEC/STEC = Enterohemorrhagic or Shiga Toxin-producing Escherichia coli 

56 
2-201.11 / 2-201.12 Decision Tree 1. When to Exclude or Restrict a Food 

Employee Who Reports a Symptom and When to Exclude a Food Employee 

Who Reports a Diagnosis with Symptoms Under the Food Code

Is the Food Employee reporting listed symptoms?

Yes

Symptoms of V.J.D.

Exclude per 

Table 1a.

Symptoms of infected 

wound or cut

Restrict per 

Table 1a.

Symptoms of ST with F

HSP

Exclude per 

Table 1a.

Gen. Pop. 

(Non-HSP)

Restrict per 

Table 1a.

If reporting a diagnosis with hepatitis A virus, 

or typhoid fever

Exclude per 

Table 1b.

If reporting a diagnosis with shigellosis, Norovirus,

or EHEC/STEC and symptoms of V or D

Exclude per 

Table 1b.

Key: 

Listed Symptoms for Reporting: (V) Vomiting; (J) Jaundice; (D) Diarrhea; (ST with F) Sore 

Throat with Fever; (HSP) Highly Susceptible Population; and (Gen. Pop.) General Population

57
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58 
2-201.11 / 2-201.12 Decision Tree 2. When to Exclude or Restrict a Food 

Employee Who is Asymptomatic and Reports a Listed Diagnosis and When to 

Restrict a Food Employee Who Reports a Listed Exposure Under the Food Code

Is the Food Employee reporting listed symptoms?

Is the Food Employee reporting 

diagnosis with infection due to...

No

S. Typhi or 

Hepatitis A virus?

Yes

Exclude per 

Table 2 or 3.

No

Shigella spp. or EHEC?

Yes

HSP

Exclude per 

Table 2 or 3.

Gen. Pop. 

(Non-HSP)

Restrict per 

Table 2 or 3.

No

Norovirus

Yes

Gen. Pop. 

(Non-HSP)

Restrict per 

Table 2 or 3.

HSP

Exclude per 

Table 2 or 3.

No

Is the Food Employee reporting exposure to Norovirus, E. coli

O157:H7 or other EHEC, HAV, Shigella, or typhoid fever (S. Typhi)?

Yes

Gen. Pop. 

(Non-HSP)

Educate on symptoms; reinforce requirement to report 

listed symptoms; ensure compliance with good hygienic practices, 

handwashing, and no bare hand contact with ready-to-eat food.

No

No Action Necessary HSP

Restrict per Table 4.

Key: (HSP) Highly Susceptible Population and (Gen. Pop.) General Population
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Notes 

60 
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Notes 

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Notes 

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Notes 

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