Employee Health and

Personal Hygiene Handbook

IFS04 | 2020
ii

Table of Contents

1 Introduction

3 Foodborne Illness

4 Employee Health and the Food Establishment

5 Employee Health Management Responsibilities

7 Employee Health Employee Responsibilities

8 Employee Health Exclusions and Restrictions

10 Employee Health and the Americans with Disabilities Act

12 Employee Health and Highly Susceptible Populations

14 Personal Hygiene

17 No Bare Hand Contact with Ready-to-Eat Foods

18 Responding to Contamination Events

20 Forms, Tables, and Decision Trees

21 Form 1-A Conditional Employee and Food Employee Interview

23 Form 1-B Conditional Employee or Food Employee Reporting Agreement

25 Form 1-C Conditional Employee or Food Employee Medical Referral

27 Form 1-D Application for Bare Hand Contact Procedure

29 2-201.12 Table 1a Summary of Requirements for Symptomatic Food 

Employees

30 2-201.12 Table 1b Summary of Requirements for Diagnosed, 

Symptomatic Food Employees

32 2-201.12 Table 2 Summary of Requirements for Diagnosed Food 

Employees with Resolved Symptoms

34 2-201.12 Table 3 Summary of Requirements for Diagnosed Food 

Employees Who Never Develop Gastrointestinal Symptoms

36 2-201.12 Table 4 History of Exposure, and Absent Symptoms or Diagnosis

38 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

39 2-201.11 / 2-201.12 Decision Tree 2a

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

Reports a Listed Diagnosis Under the Food Code

40 2-201.11 / 2-201.12 Decision Tree 2b

When to Restrict a Food Employee Who Reports a Listed Exposure 

Under the Food Code
1

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 retail 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 has been updated to reflect the most current full 

edition of the 2017 FDA Food Code and includes the following new additions: 

1. the six highly infective pathogens that can easily be transmitted by food workers (“Big 6)

2. new section addressing response to contamination events (clean -up of vomiting and

diarrheal events)

3. new question addressing disposition of ready-to-eat food that may have been

contaminated by an employee who has been restricted or excluded.

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

that can easily be transmitted by food employees and cause severe illness. These six foodborne 

pathogens, also known as the “Big 6,” include Norovirus, the Hepatitis A virus, Salmonella Typhi, 

Shigella spp., Shiga toxin-producing Escherichia coli and nontyphoidal Salmonella. 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 

Introduction
2

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

establishment’s operation.

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 2017 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 

Protection web page at: http://www.fda.gov/RetailFoodProtection.

Source:

Adapted from the 2017 FDA Food Code, U.S. Department of Health and Human Services, Public 

Health Service, Food and Drug Administration

https://www.fda.gov/downloads/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/

UCM595140.pdf (FDA 2017 Food Code)

Acknowledgements:

• FDA National Retail Food Team

• FDA CFSAN Retail Food Protection Staff
3

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:

1. Immunocompromised; preschool age children, or older adults; and

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

living, such as a child or adult day care center, kidney dialysis center, hospital or nursing home, or 

nutritional or socialization services such as a senior center.

What are the “Big 6” foodborne pathogens?

The Big 6 is a group of highly infectious foodborne pathogens. These Big 6 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 6 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 6 includes:

• Norovirus;

• Salmonella Typhi (typhoid-like fever);

• Shiga toxin-producing Escherichia coli;

• Shigella spp. (causes shigellosis); and

• Hepatitis A virus

• Salmonella (nontyphoidal)

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.

Foodborne Illness
4

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, wrists and exposed portion of the arms

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 person in charge (PIC) 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.

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, foodcontact 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.
5

Where can food employees learn more about preventing foodborne illness and 

following effective food safety practices?

Foodborne illness information resources:

• FDA/CFSAN Foodborne Illness

https://www.fda.gov/food/recalls-outbreaks-emergencies/outbreaks-foodborne-illness

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

https://www.fda.gov/downloads/Food/FoodborneIllnessContaminants/UCM297627.pdf

• 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.

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 2017 Food Code)

Management should explain to food employees the importance of reporting specific 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, nontyphoidal Salmonella or Shiga toxin-producing 

Escherichia 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, or Shiga toxin-producing 

Escherichia 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.

Employee Health Management Responsibilities
6

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.

The manager must restrict food employees exposed to:

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

• Shigella spp. or Shiga toxin-producing Escherichia coli, for at least 3 days from exposure;

• Typhoid fever (caused by Salmonella Typhi) for at least 14 days from exposure; or

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

contact with RTE food to avoid contamination, proper handwashing, or until at least 30 days from 

the initial exposure.
7

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 6 pathogen, exposure to a Big 6 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.

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 6 pathogens;

• 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 6 

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.
8

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 6 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, or working in non-food cleaning or 

maintenance tasks.

In addition, Ready-to-eat food that may have been contaminated by an employee who has been 

restricted or excluded as specified in Section 2-201.12 shall be discarded.

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 2017 FDA Food Code.

• See Tables 1a and 1b in this handbook and in the 2017 FDA Food Code, for the appropriate action to 

take if symptoms are reported.

• See Table 2 in this handbook and in the 2017 FDA Food Code, for the appropriate action to take 

if the diagnosis reported is Norovirus, shigellosis, or Shiga toxin-producing Escherichia coli and 

symptoms have been resolved.
9

• See Table 3 in this handbook and in the 2017 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 2017 FDA Food Code, for the appropriate action to take if 

the diagnosis reported is Norovirus, shigellosis (Shigella spp.), Shiga toxin-producing Escherichia 

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 Shiga toxin-producing 

Escherichia 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.

• Prior to the food employee returning to work, ensure that more than 30 calendar days have passed 

since the last exposure.

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

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

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 6 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.
10

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 2017 Food Code.

• See Table 1a in this handbook and in the 2017 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 2017 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 2017 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.

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 disability- related 

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.
11

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

resulting from a Big 6 pathogen requests a reasonable accommodation under the ADA?

For most people, having a disease resulting from one of the Big 6 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 

6 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 6.1

Even if the individual has a disability resulting from a Big 6 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(e)(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).

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).

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.
12

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 https://www.gpo.gov/fdsys/pkg/

FR-2006-09-26/pdf/E6-15693.pdf

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.

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, sore throat with fever, and/or have a lesion with pus, or open or 

draining infected wound on the hands or wrists.

• 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.
13

• 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., Shiga 

toxin-producing Escherichia coli, Typhoid fever (caused by Salmonella Typhi), Salmonella

(nontyphoidal); or

• Reports having a diagnosis of illness from Typhoid fever (caused by 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 confirmed 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 2017 Food Code are met.
14

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.

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

Personal Hygiene
15

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 2017 FDA Food Code specifies that a handwashing sink shall be equipped to provide water at a 

temperature of at least 38°C (100°ŠF) through a mixing valve or combination faucet.

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 2017 FDA Food Code lists four different 

effective methods. These include drying the hands with heated or pressurized 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.

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 fingernails trimmed;

• Washing hands only in designated handwashing sinks; and

• Following the appropriate use of hand antiseptics.
16

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.

An FDA study published in 2018 found food establishments were frequently out of compliance with the 

Food Code recommendations for proper and adequate handwashing. In the study, the percent of food 

establishments observed to be out of compliance with handwashing recommendations ranged from 

65% in fast food restaurants to 81% in full-service restaurants.

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.
17

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 2017 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 employee 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 2017 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.

No Bare Hand Contact with Ready-to-Eat Foods

What needs to be done with food that is contaminated by food employees, consumers, or 

other persons through contact with their hands, bodily discharges, such as nasal or oral 

discharges, or other means?

The food shall be discarded as per the FDA Food Code, 3-701.11(D) Discarding or Reconditioning 

Unsafe, Adulterated, or Contaminated Food. 
18

Clean-up of Vomiting and Diarrheal Events

When an employee, customer, or other individual vomits or has a diarrheal event in a food 

establishment, there is a real potential for the spread of harmful pathogens in the establishment. 

Putting the proper response into action in a timely manner can help reduce the likelihood that food 

may become contaminated and that others may become ill as a result of the accident. The Food Code 

was recently amended to require written procedures as specified under Section 2-501.11. 

What should a written plan address?

When developing written procedures that address the need for the cleaning and disinfection of 

vomitus and/or fecal matter contamination event, a food establishment should consider:

• The procedure for containment and removal of any discharges, including airborne particulates;

• The procedure for cleaning, sanitizing, and as necessary, the disinfection of any surfaces that may 

have become contaminated;

• The procedures for the evaluation and disposal of any food that may have been exposed to 

discharges;

• The availability of effective disinfectants, such as EPA registered disinfection products sufficient 

to inactivate norovirus, personal protective equipment, and other cleaning and disinfecting 

equipment and appurtenances intended for response and their proper use;

• Procedures for the disposal and/or cleaning and disinfection of tools and equipment used to clean 

up vomitus or fecal matter; 

• The circumstances under which a food employee is to wear personal protective equipment for 

cleaning and disinfecting of a contaminated area;

• Notification to food employees on the proper use of personal protective equipment and procedures 

to follow in containing, cleaning, and disinfecting a contaminated area;

• The segregation of areas that may have been contaminated so as to minimize the unnecessary 

exposure of employees, customers and others in the facility to the discharges or to surfaces or food 

that may have become contaminated;

• Minimize risk of disease transmission through the exclusion and restriction of ill employees as 

specified in §2-201.12 of the Food Code;

• Minimize risk of disease transmission through the prompt removal of ill customers and others 

from areas of food preparation, service and storage; and

• The conditions under which the plan will be implemented.

Why are written procedures necessary?

According to the CDC, Norovirus is the leading cause of foodborne illness outbreaks in the United 

States. More specifically, Noroviruses are the most common cause of sporadic cases and outbreaks 

of acute gastroenteritis. Noroviruses can be highly contagious, and it is thought that an inoculum 

of as few as 10-18 viral particles may be sufficient to infect an individual. Transmission occurs via 

foodborne and person-to-person routes, airborne inhalation of vomitus droplets, and also through 

contact with contaminated environmental surfaces.

Responding to Contamination Events
19

In addition, the potential transmission level of Norovirus shed in the feces as levels up to 1 trillion 

viral particles per gram of feces and one projectile vomiting incident can contaminate the environment 

with 300,000 viral particles. Norovirus causes acute onset vomiting (often explosive) and diarrhea 

(also often explosive) which can contaminate surfaces and become airborne increasing the chances of 

additional infections.
20

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 Codes

• 2-201.11 / 2-201.12 Decision Tree 2a

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

Diagnosis Under the Food Code

• 2-201.11 / 2-201.12 Decision Tree 2b

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

Forms, Tables, and Decision Trees
21

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 YES / NO

lesions containing pus on the hand, wrist, an exposed

body part, or other body part and the cut, wound, or

lesion not properly covered? (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

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: Date of illness outbreak

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

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

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

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

 v. Shigellosis (last exposure within the past 3 days)
22

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 five 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 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

3. 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 STEC?

YES / NO Date of onset of illness 

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

disease outbreak of Norovirus, typhoid fever, shigellosis, 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
23

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., or Shiga

Toxin-producing Escherichia coli (STEC), nontyphoidal Salmonella 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, Either While 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 STEC infection, nontyphoidal Salmonella 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 STEC infection, or hepatitis A.

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

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 STEC infection,

or hepatitis A.

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.
24

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
25

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

The Food Code specifies, 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 STEC), nontyphoidal Salmonella or hepatitis A virus 

(hepatitis A), or

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

salmonellosis is fairly common in the U.S., 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 STEC) 

infection, nontyphoidal Salmonella 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:

Health Practitioner’s Conclusion: (Circle the appropriate one)

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

infection, E. coli O157:H7 (or other STEC infection), nontyphoidal Salmonella 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 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 

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.
26

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 

STEC infection), or hepatitis A and should be excluded from working in a food establishment.

Food employee is diagnosed with an infection from nontyphoidal Salmonella and is asymptomatic 

and should be restricted from working in food establishments serving a highly susceptible 

population and food establishments not serving a highly susceptible population.

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
27

Form 1-D Application for Bare Hand Contact Procedure

(As specified in Food Code 3-301.11(E))

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.

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;
28

• 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: 
29

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

(Facilities

Serving an HSP)

Exclusion or 

Restriction

(Facilities Not 

Serving an HSP)

Removing Symptomatic Food Employees 

from Exclusion or Restriction

RA Approval 

Required to

Return to 

Work?

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., STEC, HAV, or typhoid fever

(S. Typhi) (see Tables 1b and 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, 

STEC, HAV, or S. Typhi (see Tables 1b and 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

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(I)

Restrict

2-201.12(I)

When the infected wound or boil is properly 

covered 2-201.13(I)(1)-(3).

No

Key: Table 1a 

RA = Regulatory Authority

STEC = Shiga toxin-producing Escherichia coli

HAV = Hepatitis A virus

HSP = Highly Susceptible Population
30

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 

Required 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 a S. Typhi infection 

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

Yes

Nontyphoidal

Salmonella

Exclude

Based on 

vomiting 

or diarrhea 

symptoms, 

under 

2-201.12(A)(2)

When approval is obtained from the RA 2-201.13(G), and:

• Food employee provides medical documentation,

that states the food employee is free of a nontyphoidal 

Salmonella infection 2-201.13)(G)(1) or

• Food employee symptoms of vomiting or diarrhea 

resolved and >30 days have passed since the food 

employee became asymptomatic (2-201.13(G)(2)).

Yes

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 in No. 3.

2. Serving an HSP facility: 2-201.13(A)(4)(b): Remains 

excluded until meeting the requirements listed in No. 3.

3. Restriction or Exclusion remains until:

• Approval is obtained from 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
31

Key: Table 1b 

RA = Regulatory Authority

STEC = Shiga toxin-producing Escherichia coli

HAV = Hepatitis A virus

NTS = Nontyphoidal Salmonella

Diagnosis Exclusion

(Facilities Serving 

an HSP or Not 

Serving an HSP)

Removing Diagnosed, Symptomatic Food Employees

from Exclusion

RA Approval 

Required to

Return to Work?

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 in No. 3.

2. Serving an HSP facility: 2-201.13(A)(4)(b): Remains 

excluded until meeting the requirements listed in No. 3.

3. Restriction or Exclusion remains until:

• Approval is obtained from 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 in No. 3.

2. Serving an HSP facility: 2-201.13(A)(2)(b): Remains 

excluded until meeting the requirements listed in No. 3.

3. Restriction or Exclusion remains until:

• Approval is obtained from 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

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 in No. 3.

2. Serving an HSP facility: 2-201.13(A)(3)(b): Remains 

excluded until meeting the requirements listed in No. 3.

3. Restriction or Exclusion remains until:

• Approval is obtained from 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
32

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

Exclusion or 

Restriction

(Facilities

Serving an HSP)

Exclusion or 

Restriction

(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), 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

Nontyphoidal 

Salmonella

Restrict

2-201.12(G)

Restrict

2-201.12(G)

When approval is obtained from the RA

2-201.13(G), and:

• Food employee provides medical 

documentation, that states the food 

employee is free of a nontyphoidal 

Salmonella infection 2-201.13)(G)(1) or 

• Food employee symptoms of vomiting 

or diarrhea resolved and >30 days have 

passed since the food employee became 

asymptomatic (2-201.13(G)(2)).

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 in No. 3.

2. Serving an HSP facility: 2-201.13(A)(3)(b):

Remains excluded until meeting the 

requirements listed in No. 3.

3. Restriction or Exclusion remains until:

• Approval is obtained from 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) 

(also see Table 1b).

Yes to return 

to an HSP 

or to return 

unrestricted; 

not required 

to work on 

a restricted 

basis in a 

non-HSP 

facility
33

Pathogen 

Diagnosis

Exclusion or 

Restriction

(Facilities

Serving an HSP)

Exclusion or 

Restriction

(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 in No. 3.

2. Serving an HSP facility: 2-201.13(A)(2)(b):

Remains excluded until meeting the 

requirements listed in No. 3.

3. Restriction or Exclusion remains until:

• Approval is obtained from 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 

non-HSP 

facility

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 in No. 3.

2. Serving an HSP facility: 2-201.13(A)(4)(b):

Remains excluded until meeting the 

requirements listed in No. 3.

3. Restriction or Exclusion remains until:

• Approval is obtained from 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).

Yes to return 

to an HSP 

or to return 

unrestricted; 

not required 

to work on 

a restricted 

basis in a 

non-HSP 

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 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)

(see also Table 1b).

Yes

Key: Table 2 

RA = Regulatory Authority

STEC = Shiga toxin-producing Escherichia coli

HAV = Hepatitis A virus

HSP = Highly Susceptible Population

NTS = Nontyphoidal Salmonella
34

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

Exclusion or 

Restriction

(Facilities

Serving an HSP)

Exclusion or 

Restriction

(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?

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).

Yes

Shigella spp. Exclude

2-201.12(E)(1)

Restrict

2-201.12(E)(2)

Remains excluded or restricted until 

approval is obtained from RA 2-201.13(E)

(1), 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

Nontyphoidal 

Salmonella

Restrict

2-201.12(G)

Restrict

2-201.12(G)

When approval is obtained from the RA

2-201.13(G), and:

• Food employee provides medical 

documentation, that states the food 

employee is free of a nontyphoidal 

Salmonella infection 2-201.13)(G)(1) or 

• Food employee did not develop 

symptoms and >30 days have 

passed since the food employee was 

diagnosed 2-201.13(G)(3).

(Continued)

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
35

Pathogen 

Diagnosis

Exclusion or 

Restriction

(Facilities

Serving an HSP)

Exclusion or 

Restriction

(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?

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: Table 3 

RA = Regulatory Authority

STEC = Shiga toxin-producing Escherichia coli

HAV = Hepatitis A virus

HSP = Highly Susceptible Population

NTS = Nontyphoidal Salmonella
36

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

Exclusion or 

Restriction

(Facilities

Serving an HSP)

Facilities Not Serving 

an HSP

When Can the Restricted Food

Employee Return to Work?

RA Approval 

Required

to Return

to Work?

Typhoid fever

(S. Typhi)

Restrict

2-201.12(C)

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 has passed since the food 

employee’s household contact became 

asymptomatic.

No

Shigella spp. Restrict

2-201.12(E)

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 days have passed since 

the food employee’s household contact 

became asymptomatic.

No

Norovirus Restrict

2-201.12(D)

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 has passed since the food 

employee’s household contact became 

asymptomatic.

No

STEC Restrict

2-201.12(F)

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 has passed 

since the food employee’s household 

contact became asymptomatic.

No
37

Pathogen 

Diagnosis

Exclusion or 

Restriction

(Facilities

Serving an HSP)

Facilities Not Serving 

an HSP

When Can the Restricted Food

Employee Return to Work?

RA Approval 

Required

to Return

to Work?

Hepatitis A 

Virus

Restrict

2-201.12(B)

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 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: Table 4 

HSP = Highly Susceptible Population

BHC = Bare Hand Contact

RTE = Ready-To-Eat

GHP = Good Hygienic Practices

STEC = Shiga toxin-producing Escherichia coli
38

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

Key: Decision Tree 1

STEC = Shiga toxin-producing Escherichia coli

HSP = Highly Susceptible Population

NTS = Nontyphoidal Salmonella

Is the Food Employee reporting listed symptoms?

Yes

Symptoms of infected

wound or cut

Symptoms of sore

throat and fever

Symptoms of:

• vomiting;

• diarrhea; or

• jaundice HSP Gen. Pop.

(Non-HSP)

Exclude per Table 1a Restrict per Table 1a

If the Food Employee is reporting a diagnosis with Hepatitis A virus, NTS, or typhoid fever:

Exclude per Table 1b

If the Food Employee is reporting:

• Diagnosis with Shigellosis, Norovirus, or STEC; and

• Symptoms of vomiting or diarrhea

Exclude per Table 1b
39

2-201.11 / 2-201.12 Decision Tree 2a

When to Exclude or Restrict a Food Employee Who is Asymptomatic 

and Reports a Listed Diagnosis Under the Food Code

Key: Decision Tree 2a

STEC = Shiga toxin-producing Escherichia coli

HSP = Highly Susceptible Population

NTS = Nontyphoidal Salmonella

Is the Food Employee reporting listed symptoms?

No

Is the Food Employee reporting a diagnosis with infection?

Yes Yes Yes

NTS Shigella spp., STEC,

or Norovirus? S. Typhi or Hepatitis A

HSP Gen. Pop.

(Non-HSP)

Exclude per Table 2 or 3 Restrict per Table 2 or 3
40

2-201.11 / 2-201.12 Decision Tree 2b 

When to Restrict a Food Employee Who Reports a Listed Exposure

Under the Food Code

Key: Decision Tree 2b

STEC = Shiga toxin-producing Escherichia coli

HAV = Hepatitis A virus

HSP = Highly Susceptible Population

Is the Food Employee reporting listed symptoms?

No

Is the Food Employee reporting a diagnosis with infection?

No

Is the Food Employee reporting exposure to

Norovirus, STEC, HAV, Shigella, or Typhoid Fever (S. Typhi)?

HSP Gen. Pop.

(Non-HSP)

Yes No

Restrict per Table 4

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.
41

Notes
42
43