FOODBORNE ILLNESS RESPONSE 

GUIDELINES

For Owners, Operators and Managers of Food Establishments

CIFOR INDUSTRY GUIDELINES

3

Even though these Food Establishment Guidelines and the accompanying Tools provide comprehensive information for the Food Industry in preparation for, and/or involvement in, foodborne disease outbreak investigations, these documents are not intended to replace pre-existing 

company guidelines or local, state, or federal regulations or procedures. Industry should consider using the Guidelines and Tools to compare existing procedures, fill in gaps and update 

site-specific procedures, create procedures where they do not exist, and train staff.

DISCLAIMER 

DISCLAIMER
4

CIFOR supported the establishment of the CIFOR Industry Guidelines Workgroup to develop 

foodborne illness response guidelines to help industry in day-to-day operations and during 

investigations of foodborne illness outbreaks. 

The CIFOR Foodborne Illness Response Guidelines for Owners, Operators, and Managers of 

Food Establishments is the result of countless hours of work by the CIFOR Industry Guidelines 

Workgroup, CIFOR Council representatives, and others. The CIFOR Industry Guidelines 

Workgroup was made up of food industry representatives, consulting companies, government 

agencies, and CIFOR Council representatives (members). 

This document represents CIFOR’s strong commitment to assist the food industry in its efforts 

to take an active and educated role in the response and investigation of foodborne illness 

outbreaks. CIFOR expresses its deep gratitude to everyone who supported the development of 

these guidelines. 

Development of this document was supported by FDA and Cooperative Agreement # 

U60HM000803 and 5U38HM000449 from CDC. Printing was supported by the CDC 

Foundation. The contents of the document are solely the responsibility of the authors and do 

not necessarily represent the official views of FDA , CDC, or the CDC Foundation.

ACKNOWLEDGMENTS
Guidelines for Owners, Operators and Managers of Food Establishments

5

ACKNOWLEDGMENTS

Catherine Adams Hutt, RdR Solutions 

Consulting; (representing National Restaurant 

Association)

April Bogard, Environmental Health 

Supervisor; Minnesota Department of Health

Mary Cartagena, Consumer Safety Officer; 

U.S. Food and Drug Administration

Frank Ferko, Director, Distribution Food 

Safety & Quality Assurance; U.S. Foodservice

Tom Foegle, Vice President, Food Safety & 

Quality Assurance; Windsor Foods

Lisa Hainstock, Food Safety Specialist, 

Michigan Department of Agriculture and 

Rural Development; (CIFOR representative for 

Association of Food and Drug Officials)

Jill Hollingsworth, Senior Vice President, 

Food Safety Programs; Food Marketing 

Institute

Daryl Kellenberger, Director of Food Safety 

– U.S. Operations; McDonald’s Corporation

Kirsten Larson, Senior Specialist, Food 

Safety Program; Association of Public Health 

Laboratories

Christopher T. Melchert, Senior Manager, 

Food Safety & Quality Assurance; National 

Restaurant Association

Tomeji Miller, Health Manager; City of Plano 

Health Department, Texas

Paulo Mohyla, McDonald’s U.S. Supply 

Chain – Quality Systems Manager; McDonald’s 

Corporation

George Nakamura, President, CEO; 

Nakamura Leasing, California, (CIFOR

representative for National Environmental

Health Association)

Karen Neil, Medical Epidemiologist, Division 

of Foodborne, Waterborne and Environmental

Diseases; U.S. Centers for Disease Control and 

Prevention

David C. Nicholas, Epidemiologist/

Environmental Health Specialist Network 

(EHS-Net) Coordinator; New York State 

Department of Health

Richard Parker, Quality Assurance-Scientific 

Affairs; H-E-B Grocery

Danny Ripley, Food Inspector II; Metro 

Public Health Department, Nashville/Davidson 

County, Tennessee

Mary Sandford, Manager, Food Safety 

& Regulatory Compliance; Burger King 

Corporation

Becky Stevens-Grobbelaar, Director, Food 

Safety and Regulatory Affairs; Yum! Brands, 

Inc.

CIFOR Industry Guidelines Workgroup
cIFOR FOODBORNE ILLNESS RESPONSE

6

ACKNOWLEDGMENTS

Chair: Timothy Jones, State 

Epidemiologist, Tennessee Department of 

Health; CSTE

Chair: Joseph Russell, Health Officer, 

Flathead City-County Health Department, 

Montana; NACCHO

Robyn Atkinson-Dunn, Director, Utah 

Unified State Laboratories: Public Health; 

APHL

Rob Blake, Chief, Environmental Health 

Services Branch; CDC

David Boxrud, Molecular Epidemiology 

Supervisor, Minnesota Department of Health; 

APHL

Louisa Castrodale, State Public Health 

Veterinarian, Alaska Department of Health and 

Social Services; NASPHV

John Dunn, Deputy State Epidemiologist, 

Tennessee Department of Health; NASPHV

Kathy Fowler, Director, Kentucky Division of 

Public Health Protection and Safety; ASTHO

Lisa Hainstock, Food Safety Specialist, 

Michigan Department of Agriculture; AFDO

Roberta Hammond, CORE Response 

Manager, Office of Foods and Veterinary 

Medicine; FDA 

Scott Holmes, Manager, Environmental 

Health Division, Lincoln Lancaster County 

Health Department, Nebraska; NACCHO

Kristin Holt, USDA/FSIS Liaison to CDC, 

Food Safety and Inspection Service; USDA

Steve Ingham, Administrator, Division 

of Food Safety, Wisconsin Department of 

Agriculture, Trade and Consumer Protection; 

NASDA

Ernest Julian, Chief, Office of Food 

Protection, Rhode Island Department of 

Health; AFDO

Heidi Kassenborg, Division Director, Dairy 

and Food Inspection Division, Minnesota 

Department of Agriculture; NASDA

Bill Keene, Senior Epidemiologist, Acute 

and Communicable Disease Program, Oregon 

Public Health Division; CSTE

Mel Knight, Past President; NEHA

Susan Lance, FDA liaison to CDC, Office of 

Foods and Veterinary Medicine; FDA

Bela Matyas, Health Officer, Solano County, 

California; NACCHO

George Nakamura, President, CEO, 

Nakamura Leasing, California; NEHA

Carol Selman, Public Health Advisor, 

National Center for Environmental Health; 

CDC

Donald Sharp, Deputy Director, Food Safety 

Office; CDC

Kirk Smith, Supervisor, Foodborne, 

Vectorborne, and Zoonotic Diseases Unit, 

Minnesota Department of Health; CSTE

Regina Tan, Director, Applied Epidemiology 

Staff, Office of Public Health Science, Food 

Safety and Inspection Service; USDA

Ian Williams, Chief, Outbreak Response and 

Prevention Branch; CDC

CIFOR Council Representatives
Guidelines for Owners, Operators and Managers of Food Establishments

7

ACKNOWLEDGMENTS

Jim Blumenstock, Chief Program Officer, 

Public Health Practice; ASTHO

Jeffrey Engel, Executive Director; CSTE

Rebecca Johnson, Program Analyst; 

NACCHO

Abraham Kulungara, Director, 

Environmental Health; ASTHO

Kirsten Larson, Senior Specialist, Food 

Safety Program; APHL

Jennifer Li, Director, Environmental Health; 

NACCHO

Larry Marcum, Managing Director; NEHA

Dhara Patel, Associate Research Analyst; 

CSTE

Lauren Rosenberg, Director of Marketing 

and Communications; CSTE

Sharon Shea, Director, Food Safety Program; 

APHL 

Marion Aller, Acting Deputy Commissioner, 

Florida Department of Agriculture and 

Consumer Services; NASDA

John Besser, Deputy Chief, Enteric Diseases 

Laboratory Branch; CDC

Joseph Corby, Executive Director; AFDO

Peter Gerner-Smidt, Chief, Enteric Diseases 

Laboratory Branch; CDC

John J. Guzewich, Senior Advisor for 

Environmental Health, Center for Food Safety 

and Applied Nutrition and Science; FDA

Robert Hicks, Director, Office of 

Environmental Health Services, Virginia 

Department of Health; ASTHO

Patrick J. McConnon, Executive Director; 

CSTE

Randy Robertson, Director, Compliance 

and Investigations Division, Food Safety and 

Inspection Service; USDA

Doug Saunders, Deputy Director, Division 

of Animal and Food Industry Services, Virginia 

Department of Agriculture and Consumer 

Services; NASDA

David Sweat, Foodborne Disease 

Epidemiologist, North Carolina Division of 

Public Health; ASTHO

Robert Tauxe, Deputy Director, Division of 

Foodborne, Waterborne, and Environmental 

Diseases; CDC

CIFOR Association Staff

Contributors and Reviewers
8

DISCLAIMER ..............................................................................................................................................................................................................

ACKNOWLEDGMENTS .........................................................................................................................................................................................

BACKGROUND ...........................................................................................................................................................................................................

INTRODUCTION .................................................................................................................................................................................................

OUTBREAK INVESTIGATION PREP – RECOMMENDATIONS .....................................................................................................................

FOOD ESTABLISHMENT SELF-ASSESSMENT ..............................................................................................................................................

MEDIA .....................................................................................................................................................................................................................

STORE CLOSURE AND REOPENING ...................................................................................................................................................................

CONTROL MEASURES ...........................................................................................................................................................................................

FLOW DIAGRAM: GUIDELINES AND TOOLS .....................................................................................................................................................

TERMS AND DEFINITIONS .............................................................................................................................................................................

TOOLS ................................................................................................................................................................................................................

Tool 1 

Tool 2 

Tool 3A 

Tool 3B 

Tool 4 

Tool 5 

Tool 6 

Tool 7A 

Tool 7B

Tool 7C

Tool 7D

Tool 7E

Tool 7F

Tool 7G

Tool 8

Tool 9

Tool 10

Tool 11

Tool 12

Tool 13 

Tool 14

Illness Complaint Tracking Log Form

Customer Foodborne Illness Complaint Form

Menu Ingredient Listing Form 

Example Menu Ingredient Listing 

Employee Communications Meeting

Employee List Form

Employee Health Assessment Form

Employee Illness Decision Guide 

Example Of Employee Illness Decision Quick Guide for Person-In-Charge

(For Non-HSP Establishments)

Poster: My Story Could Change Your Life

Poster: Do I Feel Well Today?

Poster: I Should Have Stayed Home

Poster: Would You Want These People in Your Kitchen?

Poster: Don’t Let What Happened to Me Happen to You

Product Sampling Procedure

Sample Chain Of Custody Form

Distributor And Supplier Information Form

Sample Food Establishment Food Safety Checklist Form

Food Flow Chart Form

Example Employee Workstation Schematic 

Sample Re-Opening Self Inspection Checklist Form

3

4-7

9

10-11

12-20

21-22

23

24

25

26

27-29

31-78

TABLE OF CONTENTS
9

In 2009, the Council to Improve Foodborne Outbreak Response (CIFOR) developed *Guidelines 

for Foodborne Disease Outbreak Response to aid government agencies responsible for 

preventing and managing foodborne disease by establishing a foundation for outbreak response 

and encouraging a standardized foodborne disease investigation process across all government 

agencies. 

There is no standard approach utilized by public health/regulatory authorities for foodborne 

disease outbreak response. No one set of steps is appropriate for all outbreaks. The response 

varies with the outbreak and surrounding circumstances (e.g., etiologic agent, number of cases, 

and likely source of exposure).

The CIFOR Industry Guidelines outlines, clarifies, and explains the recommended role of owners, 

operators, and managers of food establishments in a foodborne illness outbreak investigation. 

The CIFOR Industry Guidelines was developed by food industry leaders and local, state, and 

federal regulatory and non-regulatory public health agencies with expertise in epidemiology, 

environmental health, laboratory science, communications, and food industry operations and 

is an example of what can be achieved to promote food safety when public health and industry 

work in partnership.

*Council to Improve Foodborne Outbreak Response (CIFOR). Guidelines for Foodborne Disease Outbreak

Response. Atlanta: Council of State and Territorial Epidemiologists, 2009.

BACKGROUND
10

INTRODUCTION TO FOOD ESTABLISHMENT

RESPONSE GUIDELINES

CIFOR recognizes the critical role the food industry plays in the prevention of foodborne 

disease and the invaluable support they can provide during the foodborne disease investigation process. The Foodborne Illness Response Guidelines for Owners, Operators 

and Managers of Food Establishments was developed as voluntary guidance for owners/operators/managers of Food Establishments (“Industry”) to help outline, clarify, and explain Industry’s recommended role in a foodborne illness outbreak investigation. It provides a step-by-step approach that Industry can take, including preparation, detection, investigation, control, and follow-up. 

The Guidelines also describes key information to assist Industry in understanding what to expect when 

first notified of potential illnesses and provides Tools to help guide Industry through the process.
Guidelines for Owners, Operators and Managers of Food Establishments

11

By using these Guidelines and included Tools, 

Industry can take an active and educated role 

in the outbreak response and investigation, 

reducing the impact to the public and their 

business. A fully coordinated investigation 

can then move more quickly and accurately, 

yielding dependable results that are in the 

interest of public health while limiting impact 

to Industry. 

Even though these Guidelines and Tools 

provide comprehensive information for Industry in preparation for and/or involvement 

in foodborne disease outbreak investigations, 

these documents are not intended to replace 

pre-existing company guidelines or local, 

state, or federal regulations or procedures. Industry should consider using these Guidelines

to compare existing procedures, fill in gaps 

and update site-specific procedures, create

procedures where they do not exist, and train 

staff. 

While foodborne outbreaks represent unique 

events and government response may vary, 

CIFOR intends these Guidelines to serve as 

a foundation for Industry involvement in the 

foodborne outbreak investigation process 

and to provide a better understanding of how 

efforts to implement recommended safe food 

handling practices on a day-to-day basis can 

inform and support a foodborne outbreak 

investigation. 

In summary, the best way you can prepare for 

an effective response in a foodborne outbreak 

is to follow basic food safety rules and regulations on a day-to-day basis.

Note: The term “Food Establishment Owner/Operator/Manager” may be used interchangeably with the term

“Industry” throughout this document and tools to describe the person or entity who owns and/or operates the 

food establishment. 

INTRODUCTION
12

The U.S. Food and Drug Administration 

(FDA) has published a model Food Code 

approximately every two years from 1993 

through 2001; and since that time, a revised 

version every 4 years. This model represents 

FDA’s best advice for a uniform system of 

regulation to ensure that food at retail is safe 

and properly protected and presented. The 

Food Code is available for adoption by government agencies as the legal basis for their food 

inspection program and assists regulatory 

jurisdictions in initiating and maintaining effective programs for prevention of foodborne 

illness. While the recommendations in these 

Industry Guidelines is based, in part, on Food 

Code recommendations, specifically those 

found in Chapter 2 and its annex on Public 

Health Reasons, it is important for users to 

understand that:

• Local and/or State regulatory and/or 

public health requirements may vary;

• Government agencies leading a foodborne outbreak investigation may differ 

from the agency engaged on a daily basis, 

and;

• Depending on specific outbreak events, 

these Industry recommendations may be 

modified by the government agency leading the outbreak investigation.

OUTBREAK INVESTIGATION 

PREPARATION – RECOMMENDATIONS 

FOR FOOD ESTABLISHMENTS

I

n the interest of public health, food safety should be a Food Establishment owner/operator/manager’s top priority. It is also good business! By understanding and implementing recommended safe food 

handling practices on a day-to-day basis, Food Establishment owner/operator/managers can not only 

reduce opportunities for contamination, survival and or growth of foodborne pathogens and prevent 

illness, they can strengthen their ability to respond effectively should foodborne illness or an outbreak occur. 
Guidelines for Owners, Operators and Managers of Food Establishments

13

Here are suggested steps to prepare for a possible outbreak investigation:

A. Have a list of key contact names and 

phone numbers (including after-hours 

numbers) available for reference. Consider 

listing information for:

• Regulatory/Health Authority Office

• Specific Regulatory/Health Inspector(s)

• Food Establishment Owner

• Food Establishment Operator/

Manager(s)

• Corporate Office (if applicable)

• Quality Assurance/QA Hotline (if

applicable)

• All Employees

• Distributors and Suppliers, including 

those used only occasionally

• Attorney or Legal Representative

B. Get to know the Regulatory/Health Authority inspector and build a good working 

relationship ahead of time. Trying to do so 

during a crisis is difficult.

C. Identify the media spokesperson for 

the Food Establishment before any emergencies occur. Consult with the Regulatory/

Health Authority, Public Relations representative and/or Legal Counsel before 

releasing any media statements regarding 

the outbreak.

D. Remember, no one knows the operation better than the owner/operator/

manager. Cooperate with Regulatory/

Health Authorities and be willing to offer 

information to them about the operations, 

food safety systems/tools, etc. that might 

help them to identify the possible source of 

illness. 

E. Be prepared to provide contact information for customers, especially for large 

group reservations, special events, or orders 

catered outside the facility. Loyalty cards 

may be a source of contact information; 

however, ensure compliance with local privacy laws and company policy.

F. If Confidential or Proprietary information is requested, be sure to tell this to the 

Regulatory/Health Authority and notify the 

Food Establishment’s legal counsel. 

G. The Regulatory/Health Authority is 

prevented by law from giving out the names 

of ill customers and other identifying information. The Regulatory/Health Authority 

will clarify what information they can release specific to an ill employee or customer. They may be able to provide information 

on numbers of people reporting illness and 

other information that does not identify 

individuals.

H. The Food Establishment owner/operator/manager must share all needed records, 

such as purchasing invoices, work schedules, etc. Certain records, such as customer 

credit card receipts, may or may not be 

able to be provided based on various local/

state laws or privacy policies of credit card 

companies. Check with the corporate office/

owner/management person to coordinate 

the data transfer while ensuring privacy 

laws or policies are followed.

I. The Food Establishment owner/operator/manager must retain records/recordkeeping including: 

• Records of employee work schedules; 

• Employee work duties;

• Purchase invoices for all foods received;

RECOMMENDATIONS
cIFOR FOODBORNE ILLNESS RESPONSE

14

• Have customers complained of any illness 

from consuming the food from your 

Food Establishment? (To record multiple 

illnesses, refer to Appendix TOOL 1 - 

ILLNESS COMPLAINT TRACKING LOG 

FORM. To record specific information 

on individuals, refer to Appendix TOOL 

2 – CUSTOMER FOODBORNE ILLNESS 

COMPLAINT FORM.)

• Were multiple illnesses reported to the 

Food Establishment by the Regulatory/

Health Authority? 

• Has the Food Establishment owner/

operator/manager (or the Food 

Establishment’s corporate office) been 

notified of illness in its employees or 

customers that may be part of a larger 

outbreak associated with a food product or 

ingredient?

NOTE: If an outbreak is suspected, share any 

information collected from customers with the 

Regulatory/Health Authority. If there are no additional 

illness reports, consult the Regulatory/Health 

Authority before continuing with any further steps in 

these guidelines.

MENU / FOOD SERVED

The Regulatory/Health Authority may need 

to gather more information on specific foods 

eaten by customers to potentially identify 

common foods or ingredients that might be 

associated with the suspected illnesses. Be 

prepared to supply it, if asked: 

• A copy of the menu or food served for 

the time period requested and meals/

foods identified.

• Information about garnishes, sauces, 

side dishes and variations on basic 

menu items. 

• A recipe or list of ingredients for each 

menu item in question —(Refer to 

Appendix TOOLS 3A and 3B – MENU 

INGREDIENT LISTING FORM AND 

EXAMPLE MENU INGREDIENT 

LISTING FORM.)

• If possible, determine the total number of meals and transactions (dinein, delivery, or carry-out) served or 

sold during the time period in question and provide this to the Regulatory/Health Authority.

HOW TO KNOW IF YOU HAVE A POSSIBLE OUTBREAK

• Records of all foods picked up locally 

by the Food Establishment (purchased 

at wholesale food establishments, grocery stores and produce markets, etc., if 

applicable).

Should illness occur, it is in a Food Establishment owner/operator/manager’s best interest 

to work with the Regulatory/Health Authority 

to determine what happened and what actions 

may be needed to prevent future illness. The 

owner/operator/manager should fully cooperate with the Regulatory/Health Authority, 

obtain all information needed for the investigation, and respond quickly. Failure to do 

so may result in additional illnesses, as well 

as a loss of reputation impacting sales, future 

business and growth.

RECOMMENDATIONS
Guidelines for Owners, Operators and Managers of Food Establishments

15

If there is a suspected outbreak involving the 

Food Establishment, it is important to communicate early and regularly with employees 

to inform them of the situation, control rumors and clarify expectations. 

At a minimum, it is suggested the following 

might be shared with employees:

A. General information about the outbreak including the organism or chemical 

causing illness, if known.

B. Preventive measures employees can 

take to protect themselves or others from 

becoming ill. Be specific to the illness in 

question, if known.

C. The expectation that all employees provide all relevant information requested by 

the Regulatory/Health Authority, including 

their health status.

D. Specific guidance on responding to 

questions by the public and/or the media, 

e.g. all question should be directed to management or a designated media spokesperson.

E. Possible collection of clinical specimens, e.g. stool or blood if requested by the 

Regulatory/Health Authority.

F. The expectation of the employee to 

have a positive interaction with the Regulatory/Health Authority when they visit the 

Food Establishment. 

G. Potential for recommended treatment 

of the employee by the Regulatory/Health 

Authority if exposed to certain diseases or 

chemicals. 

H. A review of the Food Establishment’s 

sick leave policy. It is suggested that employees who become ill with certain symptoms must notify the Person-in-Charge and 

leave work immediately. (Refer to Appendix 

TOOL 4 – EMPLOYEE COMMUNICATIONS MEETING)

If the Food Establishment participates in catering, large group reservations/special event

orders, or delivery, be prepared to provide any available contact information and meals served.

EMPLOYEE COMMUNICATIONS

LARGE ORDERS, SPECIAL EVENT ORDERS, 

CATERING OR DELIVERY

RECOMMENDATIONS
cIFOR FOODBORNE ILLNESS RESPONSE

16

Since outbreaks sometimes involve employees 

who may have infected others, were victims 

of the outbreak, or whose actions may have 

led to the outbreak, the Regulatory/Health 

Authority may ask for information regarding 

their duties, illness history, and work schedules. Be prepared to provide this information 

to the Regulatory/Health Authority if asked. 

Employee schedules, duties, and work habits 

may assist the Regulatory/Health Authority in 

determining whether the Food Establishment 

is connected to the illnesses and, if so, what 

the causative factor(s) may be and what control measures are necessary. 

Provide a list of current and former employees 

(within the time period in question) with contact information. (Refer to Appendix TOOL 

5 – EMPLOYEE LIST FORM.) The list should 

include:

A. Ex-employees who worked at the 

restaurant/Food Establishment.

B. Employees transferred in or out of the 

Food Establishment (identify Food Establishment transfer locations, dates, and 

tasks performed).

EMPLOYEE WORK HISTORY

The FDA Food Code recommends that the 

Food Establishment’s owner/operator/manager require employees to report certain 

information regarding their health or activities as they may relate to diseases that can be 

transmitted through food. Information provided by employees should include symptoms 

such as vomiting, diarrhea, jaundice, etc.; date 

when symptoms started; any diagnosis from 

a health care provider of illness that could be 

food-related; such as norovirus, hepatitis A, 

Shigella spp., etc. If this information is collected by industry on a routine basis for the 

purposes of excluding and restricting employees from work, this would provide the owner/

operator a good model of employee health 

management practices that will help ensure 

better response during a foodborne outbreak 

event.

During a suspected or confirmed foodborne 

illness outbreak, it is important to communicate with employees to assess their health, 

provide information to help in protecting 

them from illness, and to assist the Regulatory/Health Authority with their investigation. 

The Regulatory/Health Authority will usually 

ask to conduct employee interviews outside 

the presence of a Food Establishment owner/

operator/manager. The Food Establishment 

owner/operator/manager or corporate representative may also wish to conduct individual 

assessments with all employees after the Regulatory/Health Authority conducts their own, 

as these can provide valuable information on 

the following: 

EMPLOYEE ASSESSMENTS

RECOMMENDATIONS
Guidelines for Owners, Operators and Managers of Food Establishments

17

• Recent or current employee illness(es) 

or exposures that could trigger employee 

testing, restriction of work duties and/or 

exclusion from work.

• Potential exposure to communicable 

illness(es) that could require medical 

follow-up; e.g., healthcare visits, 

vaccination, etc. (Refer to Appendix TOOL 

6 – EMPLOYEE HEALTH ASSESSMENT 

FORM.)

These recommendations are intended for dayto-day operation and management of a Food 

Establishment. While this can be used as general guidance in a foodborne outbreak event, 

consultation with the Regulatory/Health 

Authority to get outbreak-specific employee 

health guidance is recommended. 

If employees are ill, the Food Establishment 

owner/operator/manager may need to restrict 

their activities or exclude them from working. 

If the Food Establishment does not already 

have a policy in place, consult with the Regulatory/Health Authority for information on 

worker restrictions or exclusions. 

• To assist in decision making when other 

guidance is not available on what actions 

to be taken if employees are/were ill, and 

return-to-work guidance, refer to Appendix TOOL 7A – EMPLOYEE ILLNESS 

DECISION GUIDE. This tool is based on 

the 2009 Food Code recommendations, 

and may differ from local/state regulations 

in the area where the Food Establishment 

is located. 

• If a Food Establishment owner/operator/

manager has knowledge of the guidance 

or regulations for worker exclusion/restriction in their jurisdiction, they may 

wish to create a quick policy reference for 

themselves. (Refer to Appendix TOOL 

7B - EXAMPLE OF EMPLOYEE ILLNESS 

DECISION QUICK GUIDE FOR PERSON-IN-CHARGE, for Establishments not 

serving highly susceptible populations, for 

a sample.) Keep in mind that this is an 

example only, and does not replace what 

may be required by local or state law in 

your area.

• Provide the Regulatory/Health Authority a 

list of all employees and specify which employees have indicated they have reported 

being ill. (SEE TOOL 5.)

• Provide the Regulatory/Health Authority a 

copy of the employee health policies.

• Also useful before, during, or after an investigation are the following *FDA posters:

TOOL 7c

My Story Could Change Your Life

TOOL 7d

Do I Feel Well Today?

TOOL 7e

I Should Have Stayed Home

TOOL 7f

Would You Want These People in Your Kitchen?

TOOL 7g

Don’t Let What Happened to Me Happen to You

*NOTE: These and more posters may be found at

www.fda.gov/foodemployeetraining

RECOMMENDATIONS
cIFOR FOODBORNE ILLNESS RESPONSE

18

It is important to protect the privacy and 

health information of both employees and 

consumers; recognize that Regulatory/Health 

Authorities are typically bound by privacy 

laws to do this. Consult with the Regulatory/

Health Authority and the Food Establishment’s legal counsel regarding local, state 

and/or federal laws regarding employee 

and consumer privacy and the protections 

required in safeguarding individual health 

information.

In some outbreak situations, it might be necessary as directed by the Regulatory/Health 

Authority for employees to be vaccinated. If 

employees do not consent to vaccination and/

or other treatment (immune globulin-IgG), 

the Regulatory/Health Authority or Food 

Establishment owner/operator/manager may 

restrict or exclude the employee from work. 

(For more information, refer to the Regulatory/Health Authority and TOOLS 7A and 7B.)

Along with interviews, clinical specimens as 

indicated by the Regulatory/Health Authority 

may be required from the employee by the 

Regulatory/Health Authority for testing to 

assess employee health and provide the Regulatory/Health Authority and/or the Food 

Establishment owner/operator/manager with 

valuable information regarding the investigation. Employee test results may do the following: 

• Provide information to help determine if 

the employee may be associated with the 

outbreak;

• Determine whether employee restrictions 

or exclusions should be put in place;

• Determine whether medical follow-up 

and/or treatment may be necessary; 

• Provide information to the investigation;

• Assist with control measures.

Be ready to provide assistance to the Regulatory/Health Authority if they determine that 

employees should undergo a health evaluation 

and/or laboratory testing. If suspect employee testing is necessary, as directed by the 

Regulatory/Health Authority, and the testing 

services are provided by a non-government 

medical facility through the Food Establishment, Industry must ensure local/federal privacy laws and any internal Risk Management 

policies are followed.

CONSUMER AND EMPLOYEE PRIVACY 

EMPLOYEE SPECIMEN TESTING

EMPLOYEE HEPATITIS A VACCINATION (where applicable)

RECOMMENDATIONS
Guidelines for Owners, Operators and Managers of Food Establishments

19

The Regulatory/Health Authority may sample foods from the Food Establishment or its 

supply chain and perform laboratory analysis 

in an attempt to find the source of the illness. 

The source of illness could be a food that was 

contaminated prior to its arrival at the Food 

Establishment or contaminated onsite by a 

sick employee; mishandled; cross contaminated from raw food or equipment; or contaminated by the consumer or other food handler/

preparer. It is important to rapidly determine 

the source of the problem and initiate control 

measures at all appropriate levels including 

the Food Establishment, Distributor, Supplier, etc.

• Immediately consult the Regulatory/

Health Authority prior to sampling, using, 

moving or discarding any food that may 

have been served during the time period of 

interest for the outbreak. Any food that is 

implicated in an outbreak should be held 

under control until the Regulatory/Health 

Authority determines if they will need to 

collect samples for laboratory analysis. 

• Industry may voluntarily choose to sample 

products and have laboratory tests performed, but should consult with the Regulatory/Health Authority before collecting 

and submitting any samples to find out if 

the Regulatory/Health Authority plans to 

do so. This is to ensure adequate product 

is available for Regulatory/Health testing 

(“split samples”) and to protect against 

accidental contamination of product. 

• Before collecting its own samples, Industry should ensure that their laboratory is 

accredited for food testing and collaborate 

with the Regulatory/Health Authority to 

identify key products of interest for sampling, what laboratory tests should be 

done, and to ensure sample integrity is 

maintained and accidental contamination 

does not occur during sampling. All sample results should be shared with the Regulatory/Health Authority. (Refer to Appendix TOOL 8 – PRODUCT SAMPLING 

PROCEDURE.) 

• Consult with food testing professionals, 

legal advisors, and/or the accredited laboratory before having the samples tested 

to make sure that correct tests are done on 

the key products of interest.

• Unopened packages of food from the same 

lot suspected of causing illness may be the 

most reliable laboratory sample. Be sure 

to secure unopened packages and store 

appropriately until release by the Regulatory/Health Authority. 

• If independent sampling is done, it is 

important for the Food Establishment 

owner/operator/manager or their representative to collect the samples appropriately and maintain the Chain of Custody of 

the samples. (Refer to Appendix TOOL 9 

SAMPLE CHAIN OF CUSTODY FORM.)

• The Regulatory/Health Authority’s test 

results will typically be considered “official” and used to determine further public 

health and/or regulatory actions.

PRODUCT SAMPLES

RECOMMENDATIONS
cIFOR FOODBORNE ILLNESS RESPONSE

20

The Regulatory/Health Authority may need 

to determine if food received by the Food 

Establishment is the source of the illness. The 

Food Establishment owner/operator/manager 

needs to provide detailed information about 

what products were received from each Distributor or Supplier that delivered to the Food 

Establishment in the time period in question. 

This includes lot numbers or other identifying 

information on the suspected foods and when 

those lot numbers were actually used by the 

Food Establishment and consumed by the 

public. 

It is also important that the Food Establishment owner/operator/manager identify any 

unusual occurrences that required them to 

use a different Supplier or product during the 

time period in question. 

• Identify Distributors and/or Suppliers of 

suspected products and provide invoices to 

the Regulatory/Health Authority.

• Identify code # or lot # of suspected/

implicated product – (Refer to Appendix 

TOOL 10 - DISTRIBUTOR AND 

SUPPLIER INFORMATION FORM.)

Distributor AND/OR Supplier INFORMATION

RECOMMENDATIONS
21

• A Food Establishment owner/operator/

manager should consider completing a 

Food Safety Checklist as a means of assessing existing operations for food safety risks. (Refer to TOOL 11 –SAMPLE 

FOOD ESTABLISHMENT FOOD SAFETY 

CHECKLIST FORM.) Keep the completed 

form(s) on file and be prepared to share 

with the Regulatory/Health Authority. If 

food safety risks are identified, address them immediately and tell the 

Regulatory/Health Authority what 

actions were taken. If unsure how to 

minimize the risk, work with the Regulatory/Health Authority to establish the most 

appropriate means of dealing with it. 

• Identify if there were any unusual circumstances that occurred during the suspected 

time in question (e.g., power outage, broken equipment, large unexpected order, 

labor shortage, etc.). Be advised that the 

FDA Food Code requires reporting of an 

imminent health hazard. (8-404.11)

• Be prepared to answer questions regarding 

receiving, storage, thawing, preparation/

cooking, holding, cooling and serving of 

suspected food items or ingredients. (Refer 

to Appendix TOOL 12 – FOOD FLOW 

CHART FORM.)

• If an employee is identified as a possible 

cause of the outbreak, provide an 

employee work location schematic that 

shows where they worked (prep, service, 

washing etc.) including date and times 

they worked. (Refer to Appendix TOOL 

13 – EXAMPLE OF EMPLOYEE WORK 

STATION SCHEMATIC.)

I

n the event of an outbreak, the Food Establishment owner/operator/manager should be aware 

that the Regulatory/Health Authority may conduct an environmental assessment. Work closely with investigators to answer questions, provide information and ensure cooperation by employees. 

FOOD ESTABLISHMENT 

SELF-ASSESSMENT 
cIFOR FOODBORNE ILLNESS RESPONSE

22

• Identify appropriate prevention and control measures.

1. If the Regulatory/Health Authority 

identifies the potential cause/agent 

and the Food Establishment still has 

the product on-hand, immediately 

pull AND hold the implicated product 

under the same conditions it would 

usually be stored (i.e., if refrigerated, 

keep it that way, etc.)– STOP SELLING 

THE ITEM.

2. Do not discard food products until the 

Regulatory/Health Authority directs 

the Food Establishment to do so. (Remember, the Regulatory/Health Authority may want to collect food samples.)

SELF-ASSESSMENT
23

• The Regulatory/Health Authority, not Industry, typically has the primary responsibility for 

public notifications/media announcements 

related to foodborne illness investigations. 

• Industry has the responsibility to work with 

Regulatory/Health Authorities to warn consumers of any unsafe products that may be in 

commerce or people’s homes. 

• Releasing information prior to any Regulatory/Health Authority statement may disrupt, 

confuse or confound the outbreak investigation and result in prolonging the investigation 

process. 

• It is advisable that the Food Establishment 

owner/operator/manager review their media 

responses in advance with the Regulatory/

Health Authority to prevent any conflict with 

the facility’s operation or the Regulatory/

Health Authority’s handling of the investigation. 

• Employees should refer any media questions 

directed at the Food Establishment to a designated single point of contact. 

• Consult with the Food Establishment’s public 

relations representative and legal counsel (if 

any) before making any statements through 

the media spokesperson. Consulting with a 

risk communications professional may be 

helpful.

• Create talking points to ensure that all staff are 

responding to customers correctly and consistently. This may be done in collaboration with 

the Regulatory/Health Authority.

MEDIA

I

f the public has heard about the investigation and the Food Establishment is being contacted by 

media, it is important for the Food Establishment owner/operator/manager to coordinate with the 

Regulatory/Health Authority to ensure an accurate and consistent message is communicated. 
24

• In addition to meeting the requirements 

specified by the Regulatory/Health Authority, a Food Establishment owner/operator/manager should successfully complete a Re-Opening Self Inspection and 

correct any violations prior to re-opening. 

(Refer to Appendix TOOL 14 – SAMPLE RE-OPENING SELF INSPECTION 

CHECKLIST FORM.)

• If the Regulatory/Health Authority has 

asked or required the Food Establishment 

to close, it is likely they will conduct an 

official re-opening inspection. 

I

f a Food Establishment has closed due to the investigation, the Regulatory/Health Authority may ask the 

Food Establishment to comply with certain requirements prior to re-opening. 

STORE CLOSURE AND REOPENING
25

• Review the most recent internal and Regulatory/Health Authority food safety inspections 

(i.e., formal inspections/audits, temperature logs, employee illness logs, daily Food Safety 

Checklists, etc.) to look for potential issues, including: 

• Were critical/priority violations identified?

• Could the critical/priority violations have contributed to this outbreak?

• Were all critical/priority violations corrected? 

I

t is recommended that a Food Establishment owner/operator/manager complete a Food Safety Checklist 

daily as a means of monitoring food safety and preventing foodborne illnesses. If no checklist is available, refer to Appendix TOOL 11 – SAMPLE FOOD ESTABLISHMENT FOOD SAFETY CHECKLIST FORM.

CONTROL MEASURES
26

FLOW DIAGRAM FOR GUIDELINES AND TOOLS

PRE-OUTBREAK INVESTIGATION PREPARATION

FOODBORNE DISEASE OUTBREAK SUSPECTED

INVESTIGATION COMMUNICATIONS MITIGATION/CONTROL

CUSTOMER COMPLAINT NOTIFICATION BY HEALTH/

REGULATORY AUTHORITY

Facility Facility

Closure

Re-Opening

Employee Product 

Hold/

Remove/

Replace

External to Health/

Regulatory

Authorities & Media

Internal to

Employees &

Business

Management

Product Employee 

Restrictions/

Exclusions/

Training

Monitor Employee 

Health and General 

Food Safety

Practices Daily

Tool #4

Employee

Communications 

Meeting

Tool #14

Re-Opening

Self Inspection Checklist Form

Tool #10

Distribution 

& Supplier 

Information

Tool #7 (a-b)

Employee

Illness Decision Guide

Tool #7 (c-g)

Employee

Illness Posters

Tool #1

Illness Complaint 

Tracking Log Form

Tool #3 (a-b)

Menu Item Ingredient Listing Form

Tool #5

Employee List Form

Tool #6

Employee Interview Form

Tool #8

Product Sampling Procedure

Tool #9

Sample Chain of Custody Form

Tool #11

Food Establishment Food Safety Checklist

Tool #12

Food Flow Chart Form

Tool #13

Facility & Work Station Schematic Example

Tool #2

Customer

Foodborne Illness 

Complaint Form
Terms and Definitions
cIFOR FOODBORNE ILLNESS RESPONSE

28

Terms and Definitions

Terms and definitions are based on those 

found in the FDA 2009 Food Code and the 

CIFOR Guidelines and have been converted to 

plain language.

Asymptomatic: When a person shows no evidence of disease or symptoms of illness.

Chain of Custody: A method of tracking evidence from the time it is collected until it is 

presented, with the goal of showing that it 

has not been tampered with while in custody. A chain of custody affidavit documents 

the evidence’s collection, transportation, and 

storage. It is often in the form of written documentation clearly showing who had control of 

the evidence and that at no time did the evidence leave their possession. 

Close Contacts: Family members, coworkers, 

associates, and other persons who are or have 

been exposed to persons with possible foodborne illness symptoms, confirmed foodborne 

infection, or virus.

Critical/Priority Violation: A provision of the 

applicable food laws, that if not followed, is 

more likely than other violations to contribute 

to food contamination, foodborne illness, or 

other environmental health hazard. 

Food Establishment: An operation that stores, 

prepares, packages, serves, vends, or otherwise provides food for human consumption, 

such as (1) a restaurant; satellite, or catered 

feeding location; catering operation if the operation provides food directly to a consumer 

or to a conveyance used to transport people; 

market; vending location; conveyance used 

to transport people; institution; or food bank; 

and (2) a business that relinquishes possession of food to a consumer directly, or indirectly, through a delivery service such as home 

delivery of grocery orders or restaurant takeout orders, or delivery service that is provided 

by common carriers. 

Food Establishment Operator/Manager: 

A person who manages the practice or business of making, transporting, holding, serving, 

or dispensing foods, such as in a restaurant or 

other food establishment.

Food Safety Professional: An individual who is 

trained and experienced in food safety, including food microbiology, quality assurance, and 

food regulation. Examples of food safety professionals include internal quality assurance 

personnel and consultants. Resources may 

be obtained by contacting Regulatory/Health 

Authorities, state or national restaurant and 

retail associations.

Highly Susceptible Population (HSP): 

Regulatory definition for persons who are 

more likely than other people in the general 

population to experience foodborne disease 

because they are: 

A. Immuno-compromised; preschool age 

children, or older adults;

AND

B. 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.

GLOSSARY
Guidelines for Owners, Operators and Managers of Food Establishments

29

GLOSSARY

Industry: The entity engaged in the processing, preparing, preserving, distributing, holding and/or serving of foods and beverages.

Jaundice: A yellow discoloration of the skin, 

whites of the eyes, etc., due to an increase of 

bile pigments in the blood. This is often a sign 

of liver inflammation, which can arise from 

infection with hepatitis A or other infections 

and conditions. 

Outbreak*: Two or more cases of a similar illness shown by an investigation to result from 

a common exposure, such as ingestion of a 

common food. An outbreak is a cluster with a 

clear association between cases, with or without a recognized common source or known 

disease agent. However, even single cases of 

certain rare and serious conditions, such as 

gastrointestinal anthrax, botulism, or cholera, 

are considered public health emergencies and 

should elicit an outbreak-like response.

Person-in-Charge: The individual present at a 

Food Establishment who is responsible for the 

operation at the time of inspection. 

Potentially Hazardous Food (Time/Temperature Control for Safety Food): Food that 

requires time/temperature control for safety 

(TCS) to limit pathogenic microorganism 

growth or toxin formation. Some examples 

are: 

A. An animal food that is raw or 

heat-treated; 

B. A plant food that is heat-treated or 

consists of raw seed sprouts, cut melons, 

cut leafy greens, cut tomatoes or mixtures 

of cut tomatoes that are not modified in 

a way so that they are unable to support 

pathogenic microorganism growth or 

toxin formation; or 

C. Garlic-in-oil mixtures that are not 

modified in a way so that they are unable 

to support pathogenic microorganism 

growth or toxin formation. 

Privacy Laws: Local, State and/or Federal 

laws designed to protect personal health information from public disclosure. An example 

may be the Health Insurance Portability and 

Accountability Act (HIPAA) Privacy Rule, enacted in 2003, which established regulations 

for the use and disclosure of Protected Health 

Information (PHI). PHI is any information 

which concerns health status, provision of 

health care, or payment for health care that 

can be linked to an individual. This is interpreted rather broadly and includes any part 

of an individual’s medical record or payment 

history.

Regulatory/Health Authority: The governmental agency responsible for matters of public health and/or regulatory jurisdiction over 

the food establishment. This may include the 

local and/or State Public Health Department, 

State Departments of Agriculture, Environmental Health or any other agencies with 

jurisdiction over food safety issues. It may 

also include the U.S. Food and Drug Administration (FDA), U.S.D.A Food Safety Inspection 

Service (FSIS), or the U.S. Centers for Disease 

Control and Prevention (CDC).

*Reference: Council to Improve Foodborne Outbreak Response (CIFOR). Guidelines for Foodborne Disease

Outbreak Response. Atlanta: Council of State and Territorial Epidemiologists, 2009.

Note: Local and State public health officials may have a different definition of “Outbreak.”

Tools for Guidance

NOTE: These tools are example forms.
cIFOR FOODBORNE ILLNESS RESPONSE

32

TOOL 1 - ILLNESS COMPLAINT TRACKING LOG FORM

Purpose: To provide an electronic linelist of complaints. Instructions: A designated person(s)-in-charge should 

be reviewing this log on a regular basis and communicating with the Regulatory/Health Authority as appropriate.

TOOL 1
Guidelines for Owners, Operators and Managers of Food Establishments

33

TOOL 1

Complainant

Phone number Food(s) consumed Comments Complainant name DATE/ TIME

ILLNESS COMPLAINT TRACKING LOG FORM
cIFOR FOODBORNE ILLNESS RESPONSE

34

TOOL 2 - CUSTOMER FOODBORNE ILLNESS COMPLAINT FORM

Purpose: This form is to be used for documenting calls 

and/or person-to-person conversations with customers 

who complain that they became sick after eating at, or 

purchasing food from, the Food Establishment.

Instructions: If the Food Establishment already has a 

form or uses another system of documentation, compare forms to ensure that the information collected 

is complete. If the person is currently experiencing 

symptoms or the Food Establishment owner/operator/

manager suspects this complaint could be part of a 

suspected or confirmed outbreak, they should report 

this information to the Regulatory/Health Authority in 

their jurisdiction. 

TOOL 2
Guidelines for Owners, Operators and Managers of Food Establishments

35

CUSTOMER FOODBORNE ILLNESS COMPLAINT FORM

Food Establishment Name: 

Address:

Name of person taking complaint:

Date complaint received: _____ /_____ /_____ (month/day/year)

Did staff person read the following statement to the complainant? □ Yes □ No

SUGGESTED COMMENTS AND QUESTIONS:

“Thank you for calling (contacting) us. We are sorry for any inconvenience or illness you may have suffered. We 

investigate claims of illness brought to our attention and would like to ask you some questions about your experience. Would you be willing to take a few minutes to provide us with more information?” □ Yes □ No 

What is your name?

What is your relationship to the ill person?

Name of person complaining of illness (if not the caller):

Ill person’s Phone:

Ill person’s Email/Other:

Ill person’s Address:

How many people ate the meal or food (regardless of whether they are ill)?

How many people are ill?

When was the meal, food consumed? Date: _____/_____/_____ (month/day/year) Time:

What did you (or the ill person) have to eat?

(ask specific questions, be sure to include beverages/ice)

When did people become ill? Date: _____/_____/_____ (month/day/year) Time:

What symptoms are/were you (or the person you are reporting for) experiencing?

NOTE: If a person still has symptoms, recommend that they consider seeking medical attention and directly notify 

the Regulatory/Health Authority. 

SUGGESTED ENDING COMMENTS:

“Thank you for your call. We regret that you had an unpleasant food experience. We hope that you are doing well 

and will give us the opportunity to serve you again in the near future.” 

Customer comments:

Food Establishment Follow-Up Actions:

Was this complaint reported to Regulatory/Health Authority? □ Yes □ No 

If yes, name of organization and date sent:

Other follow-up actions:

TOOL 2
cIFOR FOODBORNE ILLNESS RESPONSE

36

FOOD ITEM: 

Is it made in the food establishment?

 YES (If YES, complete ingredient listing below)

 NO (If NO, who is the Supplier?): 

 Lot code #s, “Use By” dates, etc.:

INGREDIENT LISTING (Specify type, brand and source, if possible)

What are the ingredients (including garnishes) for the FOOD ITEM?

Ingredient: 

Ingredient: 

Ingredient: 

Ingredient: 

Ingredient: 

Ingredient: 

Ingredient:

Ingredient: 

Ingredient: 

IF YOU SUBSTITUTED INGREDIENTS, WHAT DID YOU USE?

TOOL 3A - FOOD ITEM – INGREDIENT LISTING FORM

Purpose: The purpose of this document is to identify 

each ingredient used in a food item identified as being 

of interest in an investigation.

Instructions: Complete this form listing each ingredient in detail along with brand(s), source or sources, 

and other information. Make sure the information is 

specific (example: List “Fresh Roma Tomatoes” not just 

“Tomatoes.”) Use as many pages as necessary and be 

prepared to provide copies to the Regulatory/Health 

Authority.

TOOL 3A
Guidelines for Owners, Operators and Managers of Food Establishments

37

Purpose: This document provides an example of how to 

fill out Tool 3A.

Instructions: Review prior to filling out Tool 3A. Be 

prepared to provide an ingredient listing for any food 

items in question to the Regulatory/Health Authority. 

Below is a sample for reference:

TOOL 3B - MENU INGREDIENT LISTING EXAMPLE (Pizza)

MENU ITEM: Fabulous Jimmy’s Pizza

Is it made in the food establishment?

 YES (If YES, complete ingredient listing below)

 NO (If NO, who is the Supplier?):

 Lot code #s, “Use by” dates, etc.:

INGREDIENT LISTING (Specify type, brand and source, if possible)

What are the ingredients (including garnishes) for the pizza?

Sauce:

Canned tomato sauce: Miller brand, Italian style

Fresh garlic: purchased at XYZ grocery

Fresh basil: purchased at XYZ grocery

Toppings:

Pizza cheese: Mama’s Mozzarella, pre-shredded

Pepperoni: Bobby’s brand, pre-sliced, cooked

Sausage: Wolfy’s sausage bits, precooked, 5# bag 

Green Peppers: Fresh, whole, from Linda’s Great produce and chopped onsite

Onions: Red onion, fresh, whole, from Linda’s Great Produce

Mushrooms: Sparky’s brand sliced button mushrooms, canned, #10 size

Crust: 

Flour: White bread flour, Marcus brand

Yeast: Self-starting, Marcus brand

Salt: Iodized, Kosher-style, Marcus brand

Water: Municipal

IF YOU SUBSTITUTED INGREDIENTS, WHAT DID YOU USE?

If we run out, we may purchase precooked sausage from XYZ grocery store, usually 123 brand, 

precooked. We didn’t run out of it this time. 

TOOL 3B
cIFOR FOODBORNE ILLNESS RESPONSE

38

EMPLOYEE MEETING ATTENDANCE - 

RECOMMENDED POLICY:

It is suggested that attendance at an employee meeting be required. Employees cannot 

return to work unless they have attended 

one of the employee meetings or have been 

briefed by the management. It is recommended that a meeting roster be created so 

that you and the regulatory authority know 

who has attended the meeting and can be 

placed back on the schedule. The following is 

a script outlining suggested talking points for 

the employee meeting.

“We are meeting today to inform you of 

a confirmed (or suspected, if that’s the 

case) foodborne illness outbreak that is 

related (or possibly related) to our establishment. We will provide an overview of 

the outbreak, reinforce our illness and 

hygiene policies, and provide some instruction. We are also here to answer any 

questions that you might have.”

1. Overview of Confirmed Foodborne Illness:

• Describe foodborne illness outbreak and name the disease agent (if 

known).

“We or a representative of the Regulatory/Health Authority may speak to each 

of you in private to make sure you understand what this means and see if you 

have any questions about the foodborne 

outbreak.” 

• Review Fact Sheet (Obtain disease fact 

sheet from your Regulatory/Health 

Authority. An example could be found 

on www.foodsafety.gov. Consider 

whether you may need this information in other languages).

“We are providing you with a “Fact Sheet” 

that should answer many of the questions 

you might have.”

2. Employee Interviews:

“We are working closely with the Regulatory/Health Authority to gather information. You may be contacted to answer 

questions. The purpose of these questions 

is to gather information to determine a 

possible exposure/cause for the outbreak. 

TOOL 4 - EMPLOYEE COMMUNICATIONS MEETING

TOOL 4

Purpose: This document provides suggested Agenda 

and Talking Points for communications and meetings 

with employees.

Instructions: Review this information and prepare 

your own talking points prior to a meeting with employees. Items marked with “ ” are Meeting Leader 

duties. The recommendations under Recommended 

Policies, part C - Illness Prevention and Management 

are general in nature. Guidance specific to an actual 

outbreak event should be sought from the Regulatory/

Health Authority. 
Guidelines for Owners, Operators and Managers of Food Establishments

39

The questions may cover employee work 

history, job duties and other issues. You 

may be asked to give a specimen (e.g., 

stool, blood, etc.). You should cooperate 

fully with them. Please be open and honest 

with your responses and provide as much 

information as you can. This will also be 

an opportunity for you to ask questions.”

3. Confidentiality:

“DO NOT discuss this foodborne illness 

event with anyone other than your supervisor and the Regulatory/Health Authorities.”

4. Media Contact:

“If you are contacted by any member of the 

media (e.g. television, radio or newspaper 

reporter), direct any questions to <Media 

Contact> ____________ at <Media 

Contact Phone #> _____________ and 

let your supervisor know immediately.” 

Do not answer any questions from the 

media unless your supervisor directs you 

to do so. 

5. Review of policies:

At this time, you may want to review recommended policies regarding employee health 

and hygiene with employees. Recommended 

policies can be found below. Reinforcement 

of proper hand washing, good hygienic practices and illness prevention and management 

is very important! If it is necessary to temporarily make the glove policy more stringent, 

discuss any new requirements at this time.

“We will now review the company policies 

on handwashing, glove use, and illness 

prevention and management.”

6. Recommended Policies: 

These are considered model practices. They 

may be used as is or refined based on local 

and state regulatory codes within your jurisdiction.

A. Proper Hand Washing

How to Wash Hands:

• Wash hands at designated hand wash 

sinks only.

• Wet hands with clean, warm running water.

• Apply soap to hands and rub hands vigorously to produce lather for at least 20 

seconds.

• Thoroughly rinse soap from hands using 

clean, warm running water.

• Immediately follow the rinse procedure 

by drying hands using any of the following 

methods:

• Individual, disposable towels.

• Continuous towel system that supplies 

the user with a clean towel. 

• A heated-air hand drying device.

• A high velocity, pressurized hand drying device at ambient air temperatures.

• If individual disposable towels are used, 

use the same towel to turn off the faucet 

and then discard paper towel.

When to Wash Hands:

• After using the rest room and again upon 

entering the kitchen.

• Arriving at work and after changing into 

your uniform.

• Each time you enter the food preparation 

area. (Wait staff, servers and non-food 

handling position employees are to wash 

hands before performing direct food hanTOOL 4
cIFOR FOODBORNE ILLNESS RESPONSE

40

dling task if they have performed a nonfood handling task immediately prior).

• After treating a cut or wound on the body.

• Before preparing food.

• Before handling clean equipment and serving utensils.

• When changing tasks.

• When switching between handling raw 

protein/meat foods (such as chicken, beef 

etc.) and working with Ready-to-Eat foods 

(such as sandwiches, produce etc.).

• After handling non-food items or touching 

non-food contact surfaces.

• After touching your face, hair, clothes or 

other people, such as shaking hands.

• After handling cash, trash, washing dishes, 

sweeping, mopping, wiping dining room 

tables, chemicals or cleaning - and returning to a direct food handling task.

• Coughing, sneezing, using a handkerchief 

or disposable tissue, or blowing your nose.

• After taking a break.

• After smoking, eating or drinking.

• Before putting on clean, single-use disposable gloves.

• Between disposable glove changes.

• After caring for or handling service animals or aquatic animals (such as molluscan shellfish or crustacea in display tanks).

• Anytime contamination may have occurred.

B. Disposable glove use (Gloves are 

never a substitute for hand washing):

• Single-use disposable gloves shall be used 

for only one task such as working with 

ready-to-eat food or raw animal foods.

• Single-use disposable gloves may be required when touching ready-to-eat foods.

• Employees must wash hands prior to putting on a new pair of gloves.

• Never reuse a pair of disposable gloves 

that have been removed.

• Gloves must be immediately disposed of 

and replaced after:

• Touching the body or other people.

• Sneezing or coughing.

• Drinking, eating or smoking.

• Contact with non-food contact surface 

or item.

• They have become damaged (e.g. torn) 

or soiled.

• Changing tasks.

C. Illness Prevention and Management:

Do not come to work if you are experiencing 

ONE OR MORE of the following:

• Have any foodborne illness or any infectious or contagious disease that can be 

transmitted by food

• Are vomiting, nauseous or have a fever

• Have diarrhea or loose stools 

• Jaundice (yellowish eyes or skin)

“You might want to see a doctor depending on 

how sick you feel.”

Employees must immediately inform the 

Person-in-Charge if they:

• Have recently been or are currently experiencing nausea, vomiting, fever, sore throat 

with fever, jaundice or diarrhea.

• Have been exposed to any foodborne illness or a communicable disease that can 

be transmitted through food.

• Are being tested by a physician for any 

foodborne illness or communicable disease 

that can be transmitted by food.

• Have been confirmed by a physician with 

any foodborne illness or communicable 

disease that can be transmitted through 

food.

TOOL 4
Guidelines for Owners, Operators and Managers of Food Establishments

41

• Are aware of another employee who is ill 

with, or has been exposed to, a foodborne 

illness or communicable disease that can 

be transmitted by food.

• Live with a family member that has been 

diagnosed with a foodborne illness or com-

municable disease that can be transmitted 

by food.

• Live with an employee that has been diag-

nosed with a foodborne illness or commu-

nicable disease that can be transmitted by 

food.

• Become ill or begin to feel ill before, 

during, or after their shift.

• Have been exposed to anyone with symp-

toms of vomiting, diarrhea, sore throat 

with fever or jaundice.

Employees must immediately inform the 

Person-in-Charge if they are diagnosed with: • Salmonella Typhi • Shigella spp. • Norovirus • Enterohemorrhagic or Shiga Toxin-producing Escherichia coli (E. coli) • Hepatitis A virus • Other foodborne diseases reportable in 

your state (ask your local Regulatory/

Health Authority for the list)

Employees diagnosed with any of the diseases 

listed above might be restricted or excluded 

from work, depending on local or State regu-

lations. In some cases approval from the Reg-

ulatory/Health Authority or your physician 

may be required to return to work.

TOOL 4
cIFOR FOODBORNE ILLNESS RESPONSE

42

Purpose: To identify all current and past employees 

who worked at the Food Establishment to assist in 

information collection by Health/Regulatory Authorities and for the Food Establishment Owner/Operator/

Manager’s use.

Instructions: To be completed by Food Establishment.

TOOL 5 - EMPLOYEE LIST FORM

Owner/Operator/Manager during the period

from _____/______/______ (mm/dd/yy)

to _____/______/______ (mm/dd/yy)

(Time frame to be designated by the Regulatory/Health Authority)

Food Establishment Name: 

Address: 

Food Establishment Contact:

Phone Number:

TOOL 5
Guidelines for Owners, Operators and Managers of Food Establishments

43

EMPLOYEE LIST FORM

Phone Number

(Home)

Work at other food establishment(s) Ill during this 

time frame?

Y/N Employee Address Name Phone Number (Cell) Date of Birth (mm/dd/yy)

current Employees

(Time period to be defined by the Regulatory/Health Authority as ______/______/______ to ______/______/______ 

Local Address Y/N

(mm/dd/yy) (mm/dd/yy)

TOOL 5
cIFOR FOODBORNE ILLNESS RESPONSE

44

TOOL 5

Phone Number

(Home) Address Name Phone Number (Cell) Date of Birth (mm/dd/yy)

Past Employees

(Time period to be defined by the Regulatory/Health Authority as ______/______/______ to ______/______/______ 

Last Date

Worked

(mm/dd/yy) (mm/dd/yy)

EMPLOYEE LIST FORM
Guidelines for Owners, Operators and Managers of Food Establishments

45

TOOL 6 - EMPLOYEE HEALTH ASSESSMENT

Purpose: This tool will be used to determine if an employee should be restricted or excluded* and to support 

the investigation. This assessment tool also allows the 

person asking the questions to remind the employee of 

company health policies and provide an opportunity 

for the employee to answer any questions the employee 

may have.

Instructions: This form is based on one found in the 

2009 FDA Food Code. The Person-in-Charge or other 

designated Food Establishment person may assess the 

health of the employees using this tool, to cover a time 

period determined by the Regulatory/Health Authority. Local regulations may be different, so consult the 

Regulatory/Health Authority before beginning to use 

this form routinely. 

*NOTE: If employee has a reason for any symptoms that may be unrelated to foodborne illness, such as vomiting 

due to pregnancy, etc., please note the reason on the form next to the symptom. It should be clearly indicated to 

the employee that this information may be shared with Regulatory/Health Authorities, and may be followed by 

additional questions.

TOOL 6
cIFOR FOODBORNE ILLNESS RESPONSE

46

Date: ______ /______ /______ (mm/dd/yy)

Establishment: __________________________________ City/State: __________________________________

Employee Name: ___________________ Date of Birth: _____/_____/_____(mm/dd/yy)

1. Have you experienced any of the following symptoms within the time period of 

_____/_____/_____ (mm/dd/yy) to _____/_____/_____? (mm/dd/yy) (Check all that apply)

 Diarrhea  Fever

 Vomiting  Jaundice (yellowing of skin/eyes)

 Abdominal pain  Nausea

 Sore throat with fever  Other:_______________________________________________________

 No symptoms

2. Has anyone in your household, family member or close contacts experienced any of the following symptoms 

within the period mentioned? (Check all that apply)

 Diarrhea  Fever

 Vomiting  Jaundice (yellowing of skin/eyes)

 Abdominal pain  Nausea

 Sore throat with fever  Other:_______________________________________________________

 No symptoms

3. Did you work at this or any other food establishment during the period of

_____/_____/_____ and _____/_____/_____? (mm/dd/yy)

 Yes (If yes, answer questions below)  No

Dates worked: ____________________________________________________________________________

Positions/Tasks (examples: cook, cashier, wait staff, prep staff, dishwasher, etc.)

________________________________________________________________________________________

Foods prepared: __________________________________________________________________________

Additional instructions for the Person-in-Charge or Owner/Operator/Manager:

- Review the following disease/illness prevention guidelines with employee:

o Review of disease/illness symptoms

o Proper hand washing

o Workplace exclusion if ill

o Proper hygiene 

o Immediate notification of Person-in-Charge if symptomatic

- Let the employee know that the Food Establishment is working with the Regulatory/Health Authorities, so it is 

important to remind the employee to cooperate, stay calm and not spread rumors.

- Ask the employee if they have any questions and thank them for their assistance

CURRENTLY SYMPTOMATIC:

 Yes (if YES, consult with the Regulatory/Health Authority for clinical testing directions)

 No

*For more information on exclusions and restrictions, refer to the Regulatory/Health Authority and Tools # 7A or 7B.

TOOL 6

EMPLOYEE HEALTH ASSESSMENT
Guidelines for Owners, Operators and Managers of Food Establishments

47

HOW TO USE THE DECISION TREES AND 

TABLES:

The Decision Trees and tables should be used 

together. Start with the appropriate Decision 

Tree.

Decision Trees 1 & 2: Use these Decision Trees 

as a guide in determining whether an employee must go home or if they can work on 

a restricted basis. Management may choose 

to have a more stringent policy that requires 

sick food employees to go home. The Decision 

Trees are based on food employee symptoms, 

diagnosis (with or without symptoms) and 

exposure. To use the Decision Tree: 

• Start at the top box. 

• Answer the question in that box.

• Based on the answer provided, follow the 

arrow to the last box.

• The last box will indicate which table you 

should use.

• Go to the table that is stated in the box.

• The table will provide guidance as to 

whether the employee must go home, can 

stay at work, or if they need medical clearance to return to work.

Tables 1 – 4 The Decision Trees lead to the 

corresponding table which will aid the Personin-Charge in determining whether an employee can stay at work or go home. The Decision 

Tree also provides requirements for allowing 

the employee to return to work. 

• Go to the appropriate table based on the 

final box from the Decision Tree.

• Look at the leftmost column for the appropriate symptom or diagnosis.

• Once the correct box is located, follow 

across the boxes to determine whether the 

employee must go home (exclude) or if 

they can stay at work on a restricted basis.

• There is also a box indicating the requirements for returning to work and whether 

Regulatory/Health Authority approval is 

necessary.

TOOL 7A - EMPLOYEE ILLNESS DECISION GUIDES FOR PERSON-IN-CHARGE

For Use by Food Establishment Person-InCharge.

CONTACT YOUR REGULATORY AUTHORITY FOR THE SPECIFIC GUIDELINES IN 

YOUR AREA.

Purpose: This tool is modeled on the 2009 FDA Food 

Code and may be useful as a guide in determining what 

actions the Person-in-Charge must take to prevent the 

spread of foodborne bacteria, parasites, and/or viruses 

from the infected food worker to the food, the working 

environment, and other employees. It is also useful in 

training food workers in employee health and hygiene 

matters.

Instructions: The following tables and Decision Trees 

are an adaptation from the 2009 FDA Food Code, 

Chapter 2 and its Supplement aimed at preventing ill 

food employees from transmitting disease during the 

course of routine day-to-day management of a food 

establishment. Local and State Regulatory/Health 

Authorities may have different requirements for restriction or exclusion under these circumstances. Refer to 

your Regulatory/Health Authorities for appropriate 

employee health guidelines or requirements during a 

specific foodborne outbreak event.

TOOL 7A
48

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 FDA Food Code (Section 2-201.11/2-201.12)

Key: (V) Vomiting; (J) Jaundice; (D) Diarrhea; (ST with F) Sore Throat with Fever; (HSP) Highly Susceptible Population; (Gen. Pop.) General Population

IS THE FOOD EMPLYOEE REPORTING LISTED SYMPTOMS?

If reporting a diagnosis with Hepatitis A virus, or Typhoid fever

If reporting a diagnosis with Shigellosis, Norovirus, or EHEC/STEC and 

symptoms of V or D

Symptoms of V, J, D

Exclude per table 1a.

Exclude per table 1b.

Exclude per table 1b.

Symptoms of Infected

Wound or Cut

Restrict per table 1a.

Symptoms of ST with F

HSP gen. pop

(Non-HSP)

Yes

Exclude per 

table 1A.

Restrict per 

table 1A.
49

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 FDA Food Code (Section 2-201.11/2-201.12)

Key: (HSP) Highly Susceptible Population; (Gen. Pop.) General Population; (EHEC/STEC) = Enterohemorrhagic, 

or Shiga toxin-producing Escherichia coli; (HAV) = Hepatitis A virus

Is the Food Employee reporting diagnosis

with infection due to...

Is the Food Employee reporting exposure to Norovirus, E. coli 0157:H7 

or other EHEC, HAV, Shigella, or Typhoid fever (S. Typhi)?

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.

Yes Yes

Yes

No No No

No

No

S. Typhi or Hepatitis A 

virus? Shigella spp. or EHEC? Norovirus?

HSP

HSP

HSP gen. pop

(Non-HSP)

gen. pop

(Non-HSP)

No action

necessary

gen. pop

(Non-HSP)

Exclude per 

table 2 or 3.

Exclude per 

table 2 or 3.

Exclude per 

table 2 or 3.

Restrict per 

table 4.

Restrict per 

table 2 or 3.

Restrict per 

table 2 or 3.

Yes

IS THE FOOD EMPLYOEE REPORTING LISTED SYMPTOMS?
cIFOR FOODBORNE ILLNESS RESPONSE

50

TABLE 1a

Summary of Requirements for Symptomatic Food Employees (FDA Food Code Section 2-201.12)

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.

Key: (RA) = Regulatory/Health Authority; (EHEC/STEC) = Enterohemorrhagic, or Shiga toxin-producing Escherichia coli; (HAV) = Hepatitis A virus; (HSP) = Highly Susceptible Population.

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).

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, 

E. coli O157:H7 or other EHEC/STEC, 

HAV, or S. Typhi (see Tables 1b & 2).

When food employee provides written 

medical documentation 2-201.13(G) (1)-(3).

When the infected wound or boil is 

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

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).

No if not

diagnosed

No if not

diagnosed

No

No

Yes

EXCLUDE

2-201.12(A)(1)

EXCLUDE

2-201.12(A)(1)

RESTRICT

2-201.12(G)(2)

RESTRICT

2-201.12(H)

EXCLUDE

2-201.12(B)(1)

if the onset 

occurred within 

the last 7 days

EXCLUDE

2-201.12(A)(1)

EXCLUDE

2-201.12(A)(1)

EXCLUDE

2-201.12(G)(1)

RESTRICT

2-201.12(H)

EXCLUDE

2-201.12(B)(1)

if the onset 

occurred within 

the last 7 days

Symptom

Vomiting

Diarrhea

Sore Throat 

with Fever

Infected 

wound or

pustular boil

Jaundice

Exclusion or restriction RA Approval 

Needed to

Return to 

Work?

Facilities Not

Serving an 

HSP

Facilities

Serving an 

HSP

Removing Symptomatic Food 

Employees from Exclusion or 

Restriction

TOOL 7A
Guidelines for Owners, Operators and Managers of Food Establishments

51

TABLE 1B

Summary of Requirements for Diagnosed, Symptomatic Food Employees (FDA Food Code Section 2-201.12)

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.

Continued...

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).

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).

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

Yes

Yes to return 

to an HSP 

or to return 

unrestricted; 

not required 

to work on 

a restricted 

basis in a 

non-HSP 

facility

EXCLUDE

if within 14 days of 

any symptom, or 

within 7 days of 

jaundice

2-201.12(B)(2)

EXCLUDE

2-201.12(C)

EXCLUDE

Based on vomiting or 

diarrhea symptoms, 

under 

2-201.12(A)(2)

Diagnosis

Hepatitis A virus

Typhoid Fever (S. Typhi)

E. coli

O157:H7 or 

other EHEC/ 

STEC

Exclusion

(Facilities Serving 

an HSP or Not Serving 

an HSP)

RA Approval 

Needed to 

Return to 

Work?

Removing Diagnosed, Symptomatic 

Food Employees from Exclusion

TOOL 7A

Key: (RA) = Regulatory/Health Authority; (EHEC/STEC) = Enterohemorrhagic, or Shiga toxinproducing Escherichia coli; (HAV) = Hepatitis A virus; (HSP) = Highly Susceptible Population.
cIFOR FOODBORNE ILLNESS RESPONSE

52

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 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).

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 in 

No. 3.

3. Restriction or Exclusion remains until:

• 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 

non-HSP 

facility

Yes to return 

to an HSP 

or to

return

unrestricted; 

not required 

to work on 

a restricted 

basis in a 

non-HSP 

facility

EXCLUDE

Based on vomiting or 

diarrhea symptoms, 

under 

2-201.12(A)(2)

EXCLUDE

Based on vomiting or 

diarrhea symptoms, 

under 

2-201.12(A)(2)

Diagnosis

Norovirus

Shigella spp.

Exclusion

(Facilities Serving 

an HSP or Not Serving 

an HSP)

RA Approval 

Needed to 

Return to 

Work?

Removing Diagnosed, Symptomatic 

Food Employees from Exclusion

TOOL 7A

TABLE 1B

Summary of Requirements for Diagnosed, Symptomatic Food Employees (FDA Food Code Section 2-201.12)

Continued...

Key: (RA) = Regulatory/Health Authority; (HSP) = Highly Susceptible Population.
Guidelines for Owners, Operators and Managers of Food Establishments

53

When approval is obtained from the RA 

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

• Food employee provides medical 

documentation, which states the food 

employee is free of an S. Typhi infection 

2-201.13(C)(2) (also see Table 1b). 

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 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 201.13(E)(3)(a) (also see 

Table 1b). 

Yes

Yes to return 

to an HSP 

or to return 

unrestricted; 

not required 

to work on 

a restricted 

basis in a 

non-HSP 

facility

EXCLUDE

2-201.12(C)

RESTRICT 

2-201.12(E)(2)

EXCLUDE

2-201.12(C)

EXCLUDE

2-201.12(E)(1)

Typhoid fever

(S. Typhi) 

including 

previous illness 

with S. Typhi

(see 2-201.11 

(A)(3))

Shigella spp.

TABLE 2

Summary of Requirements for Diagnosed Food Employees with Resolved Symptoms

(FDA Food Code Section 2-201.12)

Food employees and conditional employees shall report a listed Diagnosis with symptoms immediately to the Person-inCharge.

• 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.

Continued...

TOOL 7A

Pathogen 

diagnosis

RA Approval 

Needed to 

Return to 

Work?

Removing Diagnosed Food 

Employees with Resolved Symptoms 

from Exclusion or Restriction

Exclusion or restriction

Facilities Not

Serving an 

HSP

Facilities

Serving an 

HSP
cIFOR FOODBORNE ILLNESS RESPONSE

54

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 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).

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 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).

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 1b). 

Yes to return 

to an HSP 

or to return 

unrestricted; 

not required 

to work on 

a restricted 

basis in a 

non-HSP 

facility

Yes to return 

to an HSP 

or to return 

unrestricted; 

not required 

to work on 

a restricted 

basis in a 

non-HSP 

facility

Yes

RESTRICT

2-201.12(D)(2)

RESTRICT

2-201.12(F)(2)

EXCLUDE

if within 14 days 

of any symptom, or within 7 

days of jaundice

2-201.12(B)(2)

EXCLUDE

2-201.12(D)(1)

EXCLUDE

2-201.12(F)(1)

EXCLUDE

if within 14 days 

of any symptom, or within 7 

days of jaundice

2-201.12(B)(2)

Pathogen 

diagnosis

RA Approval 

Needed to 

Return to 

Work?

Removing Diagnosed Food Employees with Resolved Symptoms from 

Exclusion or Restriction

Hepatitis A virus

Norovirus

E. coli

O157:H7 or 

other EHEC/ 

STEC

TOOL 7A

Exclusion or restriction

Facilities Not

Serving an 

HSP

Facilities

Serving an 

HSP

Continued...

TABLE 2

Key: (RA) = Regulatory/Health Authority; (EHEC/STEC) = Enterohemorrhagic, or Shiga toxinproducing Escherichia coli; (HAV) = Hepatitis A virus; (HSP) = Highly Susceptible Population.
Guidelines for Owners, Operators and Managers of Food Establishments

55

Pathogen 

diagnosis

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 a S. Typhi infection 2-201.13(C)(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).

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).

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).

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).

EXCLUDE Yes

2-201.12(C)

RESTRICT

2-201.12(E)(2)

EXCLUDE

2-201.12(C)

EXCLUDE

2-201.12(E)(1)

Typhoid fever

(S. Typhi) including previous 

illness with S. Typhi (see 2-201.11 

(A)(3))

Shigella spp.

Yes to return to 

an HSP or to 

return unrestricted; not required 

to work on a 

restricted basis in 

a non-HSP facility

Yes to return to 

an HSP or to 

return unrestricted; not required 

to work on a 

restricted basis in 

a non-HSP facility

Yes to return to 

an HSP or to 

return unrestricted; not required 

to work on a 

restricted basis in 

a non-HSP facility

Yes

RESTRICT

2-201.12(D)(2)

RESTRICT

2-201.12(F)(2)

EXCLUDE

2-201.12(B)(3)

EXCLUDE

2-201.12(D)(1)

EXCLUDE

2-201.12(F)(1)

EXCLUDE

2-201.12(B)(3) Hepatitis A virus

Norovirus

E. coli

O157:H7 or 

other EHEC/ 

STEC

Exclusion or restriction

Facilities not

serving an 

HSP

Facilities

serving an 

HSP

TABLE 3

Summary of Requirements for Diagnosed Food Employees Who Never Develop Gastrointestinal Symptoms (FDA 

Food Code Section 2-201.12)

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.

TOOL 7A

RA Approval 

Needed to 

Return to 

Work?

Removing Diagnosed Food Employees with Resolved Symptoms from 

Exclusion or Restriction

Key: (RA) = Regulatory/Health Authority; (EHEC/STEC) = Enterohemorrhagic, or Shiga toxinproducing Escherichia coli; (HAV) = Hepatitis A virus; (HSP) = Highly Susceptible Population.
cIFOR FOODBORNE ILLNESS RESPONSE

56

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.

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. 

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.

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.

2-201.13(I)(4)

When any of the following conditions is met:

• The food employee is immune to HAV infection because or a prior illness from HAV, vaccination against HAV, or lgG 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.

Pathogen 

diagnosis

Typhoid fever

(S. Typhi)

Shigella spp.

RA

approval 

needed?

When can the restricted 

food employee return to 

work?

No

RESTRICT

2-201.12(I) Norovirus

E. coli O157:H7 

or other 

EHEC/ STEC

Hepatitis A virus

TOOL 7A

Exclusion or restriction

Facilities Not

Serving an 

HSP

Facilities

Serving an 

HSP

TABLE 4

History of Exposure, and Absent Symptoms or Diagnosis (FDA Food Code Section 2-201.12)

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.

RESTRICT

2-201.12(I)

RESTRICT

2-201.12(I)

RESTRICT

2-201.12(I)

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.

Educate food employee on symptoms to 

watch for and ensure 

compliance with GHP, 

handwashing and no 

BHC with RTE foods.

Educate food employee on symptoms to 

watch for and ensure 

compliance with GHP, 

handwashing and no 

BHC with RTE foods.

Educate food employee on symptoms to 

watch for and ensure 

compliance with GHP, 

handwashing and no 

BHC with RTE foods.

Educate food employee on symptoms to 

watch for and ensure 

compliance with GHP, 

handwashing and no 

BHC with RTE foods.

No

No

No

No

Key: (RA) = Regulatory/Health Authority; (EHEC/STEC) = Enterohemorrhagic, or Shiga toxin-producing 

Escherichia coli; (HAV) = Hepatitis A virus; (HSP) = Highly Susceptible Population; (GHP) = Good Hygienic 

Practices; (RTE) = Ready-to-Eat foods; (BHC) = Bare Hand Contact.
Guidelines for Owners, Operators and Managers of Food Establishments

57

(For Establishments not serving highly susceptible populations)

CONTACT YOUR LOCAL REGULATORY/

HEALTH AUTHORITY WITH QUESTIONS 

REGARDING A SPECIFIC OUTBREAK 

EVENT

Purpose: It serves as an example document that a Food 

Establishment owner/operator/manager might create as a quick guide in determining what actions the 

Person-in-Charge must take to prevent the spread of 

foodborne bacteria and/or viruses from the infected 

food worker to the food, the working environment, 

and other employees. Note that this tool does not take 

into account the requirements for the Americans with 

Disabilities Act. This tool is not a replacement of the 

requirements as specified by Chapter 2 of the 2009 

FDA Food Code or other State or local regulations on 

exclusion or restriction of employees.

Instructions: Some states have different or additional 

requirements for restriction or exclusion. Please refer 

to the local or state Regulatory/Health Authorities 

for applicable employee illness guidelines within your 

jurisdiction if you wish to develop a quick guide for 

reference in your Food Establishment. Detailed Decision Trees and tables can be found in Annex 3 of the 

2009 FDA Food Code (Section 2-201.11 and 2-201.12) 

to also assist in developing a quick guide. NOTE: If 

a Food Establishment is serving a highly susceptible 

population (HSP) such as a health care facility, child or 

adult day care center, senior center, etc., it must use the 

appropriate guidance for their jurisdiction. 

TOOL 7b - EXAMPLE OF EMPLOYEE ILLNESS DECISION QUICK GUIDE FOR FOOD ESTABLISHMENT PERSON-INCHARGE

NOTE: Non-typhoidal Salmonella is a pathogen that can be transmitted by food employees and it is commonly observed in foodborne outbreaks. However, it is not specifically referenced in Tool 7A or 7B at this time. If 

employees are reporting illness with non-typhoidal Salmonella, it is recommended that the Regulatory/Health 

Authority be notified for further guidance.

TOOL 7B
cIFOR FOODBORNE ILLNESS RESPONSE

58

TOOL 7B

Send employee home

Restricted Jobs only

Restricted Jobs only

Restricted Jobs only

Restricted Jobs only

Send employee home

Restricted Jobs only

Send employee home AND

Report to Regulatory/Health 

Authority

Send employee home

AND

Report to Regulatory/Health 

Authority

After 24 hours without symptoms

30 days after last exposure OR immediately if employee is immune, vaccinated, 

or has received an lgG inoculation

14 days after last exposure

3 days after last exposure

When wound is covered or healed

After 24 hours without symptoms

With doctor’s note

Regulatory/Health Authority 

Approval Required

Regulatory/Health Authority 

Approval Required

Vomiting

Hepatitis A

Typhoid fever (Salmonella Typhi)

E. coli O157:H7 

or other EHEC/ STEC

Hepatitis A

Infected wound or boil

Shigella

Diarrhea

Typhoid fever (Salmonella Typhi)

Sore Throat with Fever

Norovirus

Jaundice

(yellow skin or eyes)

E. coli O157:H7

or other EHEC/ STEC

When to return to work 

or off restriction:

When to return to work 

or off restriction:

When to return to work:

Person-in-Charge take 

these actions:

Person-in-Charge take 

these actions:

Person-in-Charge take 

these actions:

If an employee has 

symptoms of:

If an employee has 

been exposed to someone diagnosed with:

If an employee has 

been diagnosed with:

Restricted Jobs only

Restricted Jobs only

3 days after last exposure

2 days after last exposure

Shigella

Norovirus

Key: (Restricted Jobs) = A restricted employee cannot work with exposed food, clean equipment, utensils, linens, 

or unwrapped single-service or single-use articles; (EHEC/STEC) = Enterohemorrhagic, or Shiga toxin-producing 

Escherichia coli

EXAMPLE OF EMPLOYEE ILLNESS DECISION QUICK GUIDE FOR FOOD ESTABLISHMENT PERSON-IN-CHARGE
59

My Name Is Mariela and My Story Could Change Your LifeI felt sick in the middle of the night, but I had to go to work the next day. Protect People Everywhere.Stay home if you are sick.

I should have stay home, but I felt At work, I picked up the chips with my There was a family celebrating their son’s 

better. I didn’t know the germs from bare hands. 4th birthday. His name was Jose Antonio. 

my sickness were on my hands.

Jose Antonio loved the chips I served him. I While I was at home sick, reports started coming into the health If I could do it over again, I would have never went home an hour later because I felt sick department from all over. In all, over 20 people got sick from gone to work that day. Having a child myself, I again. I was sick for two more days. eating at our restaurant. They determined that I served all of can’t get little Jose Antonio out of my mind. He 

the people that were sick. suffered because of me. 

TOOL 7C
60

Before you go to work, ask yourself: “Do I feel well today?”

Protect People Everywhere By Not Working When You Are Sick.

TOOL 7D
61

I woke up feeling awful. I had diarrhea and was All I wanted to do was go back to bed, but with I got to work and punched in. I am sure I looked as 

sick at the same time. bills piling up, I couldn’t afford to stay home. bad as I felt. I knew I shouldn’t be here.

Orders were stacking up, so I immediately began Carlos was having a great time with his family. This When the food came, he dug right in and 

to prepare burgers. was his favorite restaurant. finished his burger and part of his sister’s.That night, Carlos doubled over with a stomach I found out 33 other people got ill from me ache. He was so sick. He ended up being taken to handling their food when I was sick. The the emergency room. Health Department closed the restaurant. 

I should have done what I knew was right and stayed home. I could have prevented all of this. Because the restaurant was closed for awhile, I lost income. I was also embarrassed.

I Should Have Stayed Home

Protect People Everywhere. Stay home if you are sick.

TOOL 7E
62

Would you want these people in your kitchen?

Then why would you go to work sick?

Protect People Everywhere... 

Stay Home When You Are Sick.

Vomiting

Sore Throat with Fever

Diarrhea

Yellow Skin/Eyes (Jaundice)

TOOL 7F
63

Don’t Let What Happened to Me, Happen to You

Protect People Everywhere: Wash Your Hands, Use Gloves or Utensils, and Never Work When You Are Sick.

My name is David. One day, while at I felt better, so I returned to finish my I did not know I had germs on my . . . and to the cucumbers . . . 

work, I started feeling sick and ran for shift. I needed the money. An order hands. I passed my germs to the the bathroom. came in for a salad. I forgot to wash tomatoes . . . 

my hands or wear gloves.

 . . . and to the entire salad . . . . . . and to a little girl named Ashlynn who ate the salad that I prepared. The next day, Ashlynn got so 

sick with stomach cramps and vomiting. In fact, dozens of people got sick because I continued to prepare food that day.

I could have prevented this from happening. 

TOOL 7G
cIFOR FOODBORNE ILLNESS RESPONSE

64

If the Regulatory/Health Authority comes into 

your store or contacts you asking to collect 

food samples, ask them where you should 

hold the product in the food establishment

• If not already frozen, DO NOT FREEZE 

unless directed to do so by the Regulatory/

Health Authority.

• If the food is already frozen, DO NOT 

THAW.

• If product is intended to be held at room 

temperature, continue doing so unless 

directed differently by the Regulatory/

Health Authority.

If you consider testing, it is strongly recommended that samples be collected from 

the same product container that the suspect 

meal came from, if still available. Often, if 

the Regulatory/Health Authority is collecting 

food samples, and there is sufficient quantity 

available, they can collect additional samples 

and provide them to the Food Establishment. 

This is termed ‘split sampling.’

If the Regulatory/Health Authority does not 

plan to collect food samples, coordinate sampling and analysis with a private accredited 

laboratory or through your corporation (if 

applicable). If you are sampling your food to 

have it tested at a private accredited laboratory, it is important you follow the procedures 

below and complete the attached form to keep 

in your files. You may wish to verify these procedures with your lab to ensure that you are 

submitting an adequate amount of product in 

an acceptable container.

TOOL 8 - PRODUCT SAMPLING PROCEDURE

TOOL 8

Purpose: This tool directs product sampling by the 

Food Establishment owner/operator/manager when 

appropriate. Food samples and test results can often 

be one of the most important pieces of information in a 

foodborne illness or outbreak investigation. 

Instructions: If you plan to collect a sample and submit 

it for laboratory analysis, you should first discuss this 

with the Regulatory/Health Authority. This will help 

ensure that the authorities are aware that suspect food 

is available for sampling, that sufficient product may be 

available for split samples, and to minimize the chances of accidental contamination. DO NOT DISCARD 

SUSPECT FOOD SAMPLES UNTIL YOU HAVE FIRST 

DISCUSSED THIS WITH REGULATORY/HEALTH 

AUTHORITIES. 
Guidelines for Owners, Operators and Managers of Food Establishments

65

1. Product sampling standard operating procedures

a. Clearly label suspect products “DO NOT 

USE” and set aside from regular inventory.

b. Wash, rinse and sanitize the surface you 

will work on to collect the sample.

c. Wash and sanitize hands, and put on a 

new pair of single-use gloves.

d. Place the container of the product to be 

sampled on the sanitized surface.

e. Get a new and clean food grade bag or 

plastic wrap.

f. Using a cleaned and sanitized utensil, 

place the appropriate amount specified by 

the laboratory (or as much as you have if you 

don’t have enough left) of product in the bag 

or on the plastic wrap, being careful not to 

touch the product or the inside of the bag or 

wrap with your hands.

g. Seal the bag (no staples) or wrap the plastic securely around the product.

2. Clearly label samples “DO NOT USE.”

3. Ask the Regulatory/Health Authority which 

tests should be run on the product and write 

these down:

Tests to be conducted: 

_______________________________

4. Record the following information when collecting individual samples and keep on file.

a. Name of product

b. Product brand, if applicable

c. Date product was prepared or handled 

at the Food Establishment, if possible

d. USDA establishment number, if 

applicable

e. Direct Supplier identification 

information

f. Use by date(s) (including lot numbers, if 

applicable)

g. Sample number(s), (sample A, B, C or 1, 

2, 3, etc.)

h. Date and time sample was collected

i. Where sample was collected from (e.g., 

freezer, cooler, make table, salad bar, etc.)

j. Name of the person who collected the 

sample

5. Record the following information and 

include with the samples submitted to the 

laboratory:

a. Name of product

b. Product brand, if applicable

c. Date and time sample was collected

d. Where product was collected from (e.g., 

freezer, cooler, make table, salad bar, etc.)

e. Name of the person who collected the 

sample

6. Label remaining suspect product “DO NOT 

USE” and place in the walk-in cooler (if it is 

a refrigerated product) or freezer (if it is a 

frozen product). 

7. Submit the samples in accordance with the 

laboratory instructions.

TOOL 8
cIFOR FOODBORNE ILLNESS RESPONSE

66

Purpose: To legally document that a sample was 

under the direct control of an individual while it was 

in their possession.

Instructions:

Submitter Information

• Filled out by collecting person 

Sample Identification

• Filled out by collecting person 

• May use form for more than one sample

• Number the items 1,2,3, etc., corresponding to the total number of samples

• Describe the sample briefly – including 

condition of specimen and container if 

applicable

• Describe how the sample was collected and 

how much of the sample was collected

• If a sample is transferred externally, it is 

important to make a copy of this form and 

retain for the file.

Receipt of Sample

• This is where the collected items get 

turned over to the lab. If they change 

hands for some reason before reaching 

the lab, they must be transferred on paper 

from person to person. Use the second line 

in the Receipt of Sample section to record 

this information.

• Must list which items are being transferred 

in the item number column. These will 

most likely be “ALL”.

• Reason for transfer must be given – (example-transport to lab, testing, etc.).

• The original form must accompany the 

sample to the receiving lab.

TOOL 9 - SAMPLE CHAIN OF CUSTODY FORM

TOOL 9
Guidelines for Owners, Operators and Managers of Food Establishments

67

Food Establishment: Phone #:

Address:

City: Fax #:

State: Zip:

Contact person:

Outbreak Name - if applicable:

Collection Location:

Item number Description of Sample Sample Collection (Partial/Whole Sample)

Date Item number(s) Sample Released by

 Signature

 

 Name (printed)

 

 Signature

 

 Name (printed)

Miscellaneous comments:

Submitter Information

Sample Identification

Receipt of Sample

TOOL 9

Sample Chain of custody Form

Sample Received by Reason for transfer

Signature

Name (printed)

Signature

Name (printed)
cIFOR FOODBORNE ILLNESS RESPONSE

68

If information concerning ingredients, 

groups of ingredients, product types, 

and/or menu items is requested by 

Regulatory/Health Authority, provide 

the name of the Distributor and/or source, 

the name of the Packer or the Supplier of the 

product, and wherever possible, the lot number(s) or other identifying information, on 

this Tool. Do only for the ingredients, groups 

of ingredients, product types, and/or menu 

items identified by the Regulatory/Health 

Authority. As the investigation continues, additional information may be requested by and 

should be provided to the Regulatory/Health 

Authority.

• Assemble all Distributor invoices, receiving documents, product records, and 

receipts for all foods of interest purchased 

off-site by the establishment and brought 

back to the establishment. 

• The Food Establishment owner/operator/

manager must report all product of interest used during the time period, regardless 

of when or where it was purchased. 

• Please include special purchases including fill-in purchases from local markets or 

grocery stores. 

• Assemble any records (example: inventories or stock records) that will help you 

determine when the products may have 

been used.

TOOL 10 - Distributor AND Supplier INFORMATION FORM

TOOL 10

Name of Product,

and Name of

Originating Packer/

Supplier, if known. 

Include lot codes, if 

known

Name of Product, 

and

Name(s) of Company 

(Packed by/

Distributed by) on 

package

Dates and Times of 

Delivery/Receipt at 

Food Establishment 

during Period 

of Time Under 

Investigation

Distributor(s) or 

Source(s) (food 

market, retail store, 

etc): Name,

Address, City, State, 

Zip

Name of

Ingredients

and/or menu items

EXAMPLE: Menu Item: 

Hamburger Sandwich

Ground beef patties

4” frozen buns

Shredded Lettuce

5 X 5 whole Tomatoes

Beef Patties and Buns from 

ABC Distributing, 123 Shell 

St, Chicago, IL 60007

Lettuce and Tomatoes from 

XYZ Produce, 98 Rose St, 

Chicago, IL

Whole lettuce, Grocery 

Store X

ABC delivered on 3/29, 4/5 

and 4/8

(see invoices)

XYZ delivered on 3/29, 

4/1,4/3, 4/5, 4/8 and 4/10

4/6 picked up

4 oz All Beef Patties – Distributed by ABC Brand

4” Sandwich Buns – packed 

by Fun Bakery

Shr. Lettuce – Trap Brand

Tomatoes – Big-T Brand

Whole Lettuce – Unknown

Patties – Maine Beef,

Lewiston, ME

Buns – Fun Bakery, Atlanta

Lettuce – Ready Produce, 

Salinas, CA

Tomatoes – Unknown

Whole Lettuce – Unknown

Purpose: The purpose of this Tool is to document the 

immediate sources of food ingredients received by the 

Food Establishment during an outbreak investigation. 

The information will be used in determining sources of 

food common to ill persons. Since sources of ingredients can vary from day to day, it is critically important 

to provide accurate and complete information.

Instructions: Regulatory/Health Authority and/or 

Food Establishment owner/operator/manager will 

identify possible ingredients, groups of ingredients, 

product types, and/or menu items that may be indicated as linked to foodborne illness, along with a time 

period of concern. (The Food Establishment owner/

operator/manager may want to identify all sources of 

foods to better prepare to provide information on all 

sources as the investigation develops). 
Guidelines for Owners, Operators and Managers of Food Establishments

69

Distributor and Supplier Information Form - Part 1

Date:

Person completing the form:

Title:

Food Establishment name:

Address:

Contact name: Phone:

The “Period of Time Under investigation” is from ______/______/______ to ______/______/______ (month/day/year)

Lot numberS or other identifying numbers (date of pack/use by date):

Please explain if you track or record original lot numbers on products that you use.

Provide the individual product/ingredient shelf life, both the use by or sell by dates, as well as how quickly the product 

was rotated through the food establishment during the time frame in question.

TOOL 10
cIFOR FOODBORNE ILLNESS RESPONSE

70

Name of product, 

and name of originating Packer/Supplier, if known. (The 

Supplier’s facility 

that packed the 

package.) Include 

lot codes, if known

Dates and times of

Delivery/Receipt at 

Food Establishment 

during period of time 

Under Investigation

Name of product, and

name(s) of Company

(packed by/distributed by) 

on package

Distributor(s) or Source(s)

(food market, retail store, 

etc): Name, Address, City, 

State, Zip

Name of

ingredients and/

or menu items

TOOL 10

Distributor and Supplier Information Form - Part 2
Guidelines for Owners, Operators and Managers of Food Establishments

71

TOOL 11 - SAMPLE FOOD ESTABLISHMENT FOOD SAFETY CHECKLIST FORM

PURPOSE: Use for self-assessment 

INSTRUCTIONS:

• May be used twice a day

• Y = YES, N = NO

• Indicate Action Taken on all “NO” responses 

• Food Establishment Person-in-Charge signs off on 

completed checklist

• Prompt corrective action on “NO” responses could 

prevent Health/Regulatory Authority violations or 

customer illness and complaints. Check with local 

or state regulatory requirements to ensure local 

compliance. See disclaimer on page 3.

TOOL 11
cIFOR FOODBORNE ILLNESS RESPONSE

72

TOOL 11

CIFOR Tool #11 Page 1 of 3

SAMPLE FOOD ESTABLISHMENT FOOD SAFETY CHECKLIST FORM

PURPOSE:Use for self assessment

INSTRUCTIONS: ■ May be used twice a day ■ Y = YES, N = NO ■ Indicate Action Taken on all “NO” responses ■ Food Establishment Person 

in Charge signs off on completed checklist ■ Prompt corrective action on “NO” responses could prevent Health/Regulatory Authority

violations or customer illness and complaints. Check with local or state regulatory requirements to ensure local compliance. See page 3.

Food Establishment:_______________________________ MORNING (Opening-3 pm) EVENING (3 pm – closing)

Person in Charge on Duty:____________________________ Name / Time Name / Time

Date: __________________ SU MN TU WE TH FR SA ________/________ ________/________

FROZEN STORAGE Opening P.M.

1. Walk-in Freezer ___°F ___°F

2. Reach-in freezer ___°F ___°F

COLD STORAGE (< 41o F) Opening P.M.

1. Walk-in cooler ___°F ___°F

2. Reach-in cooler #1: ___°F ___°F

Reach-in cooler #2: ___°F ___°F

3. Sandwich /Assembly Table food temps

Produce - Any Item ___________________ ___°F ___°F

Produce - Any Item ___________________ ___°F ___°F

4. Walk-in cooler food temps

Produce - Any Item ___________________ ___°F ___°F

5. Cold product dispenser machines ___°F ___°F

STORAGE (Freezer, Cooler, Dry etc.) Opening P.M. 

1. No expired products. Rotation evident. Y N Y N

2. All food labeled, dated and covered. Y N Y N

3. All ingredients/products from approved

sources. Y N Y N

4. No damaged, dented or swollen cans. Y N Y N

THAWING Opening P.M.

1. Frozen items thawed using approved 

 methods. Y N Y N

EQUIPMENT Opening P.M.

1. Working, calibrated thermometers in all 

equipment. Y N Y N

2. Working, calibrated thermometers in use. Y N Y N

3. Cook, chill or heat equipment is properly 

calibrated. Y N Y N

4. List equipment #1 ________________ ___°F ___°F

5. List equipment #2 ________________ ___°F ___°F

6. List equipment #3 ________________ ___°F ___°F

7. List equipment #4 ________________ ___°F ___°F

8. List equipment #5 ________________ ___°F ___°F

FINAL COOKING TEMPERATURE Opening P.M.

LIST FOOD ITEMS:

1. ___°F ___°F

2. ___°F ___°F

3. ___°F ___°F

4. ___°F ___°F

5. ___°F ___°F

6. ___°F ___°F

7. ___°F ___°F

COOLING (135F to 70F within 2 hours or less)

 (135F to 41F within total of 6 hours) Opening P.M.

1. Cooling products (Start ____ end time _____)

LIST FOOD ITEMS: TEMP:

Y N Y N

HOT HOLDING Typically 135° or above.

Consult Regulatory/Health Authority to verify 

regulations in your jurisdiction.

Opening P.M.

LIST FOOD ITEMS: TEMP: Y N Y N

1. Y N Y N

2. Y N Y N

3. Y N Y N

4. Y N Y N

5. Y N Y N

6. Y N Y N

7. Y N Y N

EMPLOYEE HEALTH & HYGIENE Opening P.M.

1. Hair restraints are worn in food prep area. Y N Y N

2. Sick employees are not present. Y N Y N

3. If gum, tobacco use, eating or drinking is 

observed, is in approved areas. Y N Y N

4. Proper disposable glove use procedures are 

followed, if applicable. Y N Y N

5. Employees are clean and well-groomed, with 

clean clothing. Y N Y N

6. Cross-contamination is not observed. Y N Y N

7. Personal food items properly stored.

8. Wounds are properly bandaged and covered. Y N Y N

HAND HYGIENE PRACTICES Opening P.M.

1. Hand wash sinks are properly stocked and 

accessible. Y N Y N

2. Proper, timely and adequate hand washing is 

observed. Y N Y N

3. Disposable gloves used properly. Y N Y N

4. No jewelry, except plain band. Y N Y N

PEST CONTROL Opening P.M.

1. No evidence of pest infestation. Y N Y N

2. No unapproved pesticides evident. Y N Y N

3. Pest control plan in place. Y N Y N

CLEANING AND MAINTENANCE Opening P.M.

1. Chemical and cleaning supplies are properly 

labeled, stored and from approved sources.

Y N Y N

2. Three-compartment sink or dish machine is set 

up properly.

Y N Y N

3. Sanitizer test strips are readily available. Y N Y N

4. Sanitized wiping cloths are stored properly. Y N Y N

5. Plumbing is operable sewage and/or waste 

water backup is not present.

Y N Y N

6. Hot and cold running water is available in the 

restaurant and at hand wash sinks.

Y N Y N

SAMPLE FOOD ESTABLISHMENT FOOD SAFETY CHECKLIST FORM
Guidelines for Owners, Operators and Managers of Food Establishments

73

Date: Completion date:

(Complete for all “N” responses or “out of standard/policy” findings.)

1.

2.

3.

4.

5.

6.

7.

Comments:

TOOL 11

SAMPLE FOOD ESTABLISHMENT FOOD SAFETY CHECKLIST FORM

FREEZER INGREDIENT STORAGE

COLD INGREDIENT STORAGE -- Ambient Air = less than or equal to 41o F (air temperature taken with calibrated thermometer).

HAND HYGIENE

CLEANING AND MAINTENANCE

PEST CONTROL

COOKING

COOLING (135F to 70F within 2 hours or less, to 41F within total of 6 hours)

HOT HOLDING

EMPLOYEES

EQUIPMENT

THAWING

STORAGE ( Freezer, Cooler, Dry)

1. Thermometers calibration checked. Thermometer = 32o F ± 2o F in 50/50 ice water (Fill container with ice then fill to top with water covering ice. Ensure all food is frozen solid.

1-2. Thermometers calibration checked. Thermometer = 32° F + 2° F in 50/50 ice water (Fill tumbler with ice then fill to top with water covering ice).

3-4. Food Temperatures: stir product, then insert the sanitized thermometer probe 1 - 2 “ below the surface and record the stabilized temperature. Packaged items temperature: fold 

package around thermometer probe and record the stabilized temperature, or place between two packages.

1. Hand wash sinks = hot water (100° F), equipped with approved soap, single-use disposable towels, and trash can. Hand washing sign is visibly posted at every hand wash sink 

(including the restroom). Anything blocking the hand wash sink or in the hand wash sink bowl is unacceptable. HAND SANITIZER USE IS NOT A SUBSTITUTE FOR HANDWASHING!

2. Hands are properly washed for 20 seconds with hot water (100° F) and approved soap, then rinsed and dried. Hands must be washed after using the restroom, upon entering the 

Food Establishment or before handling food.

3. Use single use disposable gloves or utensils when handling ready to eat foods. Gloves must be disposed of and replaced when soiled or torn.

1. Infestation = live/dead roaches, rodents, rodent droppings, excessive flies, drain flies, boxes/packaging in storage with chew holes, evidence of nesting material. Mice can get in 

through a hole the size of a dime. Rats get through a hole the size of a quarter.

2. Pesticides should ONLY be applied by the PCO/Pest Control Operator.

1-8. Insert sanitized thermometer probe into the food and record stabilized temperature.

1. Cool products to 41° F within six hours after removing from line. Record time and temperature of start and end time.

1-8. Insert sanitized thermometer probe into the food and record stabilized temperature.

1. All hair must be properly restrained.

2. Sick = sore throat with fever, vomiting, diarrhea, fever, jaundice (yellow skin/eyes)

3. Eating, drinking, gum chewing or tobacco use only in designated, non-food prep/storage areas.

4. Bandages and single use disposable gloves are stocked in the first aid kit at all times. False fingernails and/or polish/decals must be covered with single use disposable gloves when 

handling food. Cuts/wounds are covered with bandage and single-use disposable glove.

5. Fingernails must be clean and trimmed, and artificial or polish-covered nails require glove use.

6. Clothing must be clean.

7. Cross contamination = any activity that could transfer harmful substances/microbes to food from utensils, hands, surfaces, etc.

8. Employee food or personal items are stored separate from production food/ingredients (covered and labeled, if in cooler or freezer).

1-2. Thermometers calibration checked. Thermometer = 32° F + 2° F in 50/50 ice water (Fill tumbler with ice then fill to top with water covering ice).

3-8. Record equipment temperatures.

1. Look for any potentially hazardous ingredients/products being thawed at room temperature. These ingredients and products must always be thawed using approved methods.

1. Products are dated with receiving date and expiration date. None are past Use By date. Rotation evident. Older products are in the front of newer products.

2. Products are labeled with name and securely covered to prevent contamination of contents.

3. All ingredients/products are approved.

4. Look for any size dents, bulging tops, and swollen sides on canned food items.

1. Chemicals are stored in a designated area away from food and food packaging. Only approved chemicals are used. All chemicals must be labeled with the name of the chemical 

(color coding only is not acceptable).

2. The three compartment sink is set up properly at all times. Check concentration of the sanitizer compartment containing the chemical with appropriate test strips.

3. Test strips are in close vicinity of the sink and/or dishwasher.

4. Wiping towels must be stored properly. Sanitizer buckets and spray bottles must be labeled “SANITIZER.”

5. All plumbing in good operating condition and there is no wastewater backup or sewage present.

6. All sinks have hot and cold running water.
cIFOR FOODBORNE ILLNESS RESPONSE

74

Purpose: The following are possible questions that may be asked about the suspect 

food(s) by the Regulatory/Health Authority 

while conducting a foodborne illness outbreak 

investigation. They should be consulted for 

more specific guidance or local examples. Additional questions specific to how the food was 

prepared or handled during the time period in 

question may also be asked by the Regulatory/

Health Authority.

Instructions: Each food item will need to be 

listed separately (include all ingredients). 

Some foods may not incorporate all these 

steps. It may require multiple forms for individual ingredients. Refer to the Process Guide 

below and complete the form on the next 

page.

TOOL 12 - FOOD FLOW CHART FORM

Date and Time received?

How was it received?

(fresh/frozen/raw/pre-package/

pre-cooked)

Supplier?

Condition acceptable?

Inspected?

Temperature (if applicable)?

Lot #?

Location?

Temperature?

First In/First Out (rotation)?

How was food thawed? Did employee monitor the temperature?

How was food portioned? Was 

food measured?

Were ingredients processed on 

same work surface? Were multiple lots or sources mixed?

How was food mixed? Was there 

hand contact?

How was food cooled?

Did employee monitor the temperature?

Cooling time?

Temperature?

Cooling at end of shift or day?

Equipment and thermometers 

calibrated? Temperature?

How was food reheated? Did employee monitor the temperature? 

Temperature?

Contamination? Holding food 

without temperature control? 

Controlling your self-service 

areas?

Temperature?

Temperature?

Temperature? Food integrity?

Receiving

Storage

Prep (D) Defrost/

Thaw

Prep (P) Portion/

Pack

Prep (B) Break 

Down

Prep (C) Combine/Mix

Other

Cool Process/

Close

Cook-Kill

Reheat

Service

Hot-Hold

Cold-Hold

Delivery or 

Catering?

Step name Questions Step name Questions

Process Guide

TOOL 12
Guidelines for Owners, Operators and Managers of Food Establishments

75

For All Prep Processes: 

Food Preparation areas cleaned and sanitized?

Produce and other foods properly washed?

Avoid cross contamination during preparation? 

Steps in process?

Possible hazards?

Possible contaminations?

Establishment Name: 

Date: 

Person Completing This Tool: 

Suspect Food Item:

Ingredients:

Step

(List Step From

Process Guide)

Notes

(Refer to Process Guide)

Food flow overview

Employee

assigned task

Step #1 - Receiving

Step #2 -

Step #3 -

Step #4 -

Step #5 -

Step #6 -

Step #7 -

Step #8 -

Step #9 -

Step #10 -

TOOL 12

FOOD FLOW CHART FORM
cIFOR FOODBORNE ILLNESS RESPONSE

76

Purpose: This tool is to provide information 

to Health/Regulatory Authorities to illustrate 

the work environment and its relationship to 

employee activities and food handling.

Instructions: Provide an employee work location schematic of where they worked (prep, 

service, washing etc.) including date and 

times they worked. Below is an example of a 

schematic. 

TOOL 13 - FACILITY AND WORK STATION SCHEMATIC EXAMPLE

TOOL 13
Guidelines for Owners, Operators and Managers of Food Establishments

77

TOOL 14 - SAMPLE RE-OPENING SELF INSPECTION CHECKLIST FORM

Purpose: This Re-Opening Self Inspection 

Checklist can be used as an example to help 

prepare the Food Establishment for re-opening. 

Instructions: Consult the Regulatory/Health 

Authority in your area to discuss the specific 

requirements for your Food Establishment 

prior to re-opening.

TOOL 14

Food Establishment Name:

Location:

Date:

Person-in-Charge Name:
cIFOR FOODBORNE ILLNESS RESPONSE

78

TOOL 14

TOOL 14 - SAMPLE RE-OPENING SELF INSPECTION CHECKLIST FORM

1. All equipment at correct storage/holding temperatures

2. Thermometer in refrigerated storage and/or holding equipment.

3. Walk-in door closes automatically.

4. All equipment/food contact surfaces are clean and sanitized (free of all grease and food 

debris), in good repair and functioning properly. Such as, not limited to:

• Drink Stations

• Heated Cabinet

• Cold Line/ Prep table

• Display Cases

• Hot wells/hot hold units

• Ice Machine (scoop stored properly)

• Ovens/microwave

• Fryers

• Grills/Clamshells/Toasters

• Gaskets (reach-in coolers etc.)

• Prep table, mixer, dough roller, etc.

5. Calibrated thermometer available to check equipment and product temperatures.

6. Utensils are clean and sanitized, free of food debris and properly stored.

7. Dishwasher is clean, equipped with soap; and sanitizer (low temp machine) or reaches 

180°F rinse (high temperature)

8. Sanitizer test strips available.

9. Wiping towels properly stored in sanitizer bucket when not in use.

1. All holes and cracks (floors, walls, ceilings, doorways) are sealed.

2. All floor/coving tiles are in good repair.

3. All lights (such as walk-in, freezer, hoods, ceiling) are in working order, covered and 

shielded.

4. Hoses/pipes have appropriate backflow device/air gap.

5. Plumbing in good repair, not leaking (sinks, toilets).

6. Excess/unused equipment, supplies, packaging etc. removed from premises to prevent 

rodent/insect harborage.

7. Hot water heater is functioning properly, hot water (100°F min.) to hand sink.

8. Dumpster area clean, lid closed, free of pests.

9. All hand wash sinks functional and fully stocked (soap, paper towels, hand wash sign 

etc.).

10.All toilets clean, functional and good working order.

11.All storage racks/shelves are 6 inches off floor, clean and free of grease and food debris.

12.All packaging, food ingredients, chemicals stored at least 6 inches off floor.

13.All floor drains clean, free of debris/flies, free flowing and have a secure grate.

14.Floor, coving, floor corners/edging free of grease, debris, and buildup.

15.Ceiling tile in good repair and ceiling is clean.

16.Dining room furniture, fixtures (lights, pictures, posters) clean and in good repair.

17.Recommend the Kitchen hand wash sink have disposable glove dispenser.

18.First Aid Kit available and stocked (bandages, CPR mask etc.).

19.Choking Poster posted as required by regulatory authority.

20.Health Permit/License available as required by regulatory/health authority.

21.Food Manager Certificate and/or Food Handler Cards current and on file.

22.Electricity and water available.

23.No sewage backup; grease traps operational – no odor.

24.No evidence of smoking, if applicable.

1. No insect infestation evident (roaches, fruit/drain/house flies)

2. No rodent issue/infestation evident

• mouse/rat feces (floor perimeter, in ceiling, attic, basement)

• urine trails (need black light to assess)

• gnawed packaging

• nesting areas

3. No unapproved pesticides and/or baited traps evident.

1. Employees or persons assigned or hired to clean facility asymptomatic for 24 hours prior 

to cleanup (i.e. NO symptoms of nausea, vomiting, diarrhea, jaundice, etc).

2. Employees assigned to clean facility AND previously diagnosed with Hepatitis A, E. coli 

O157/STEC, shigellosis, typhoid fever or Norovirus or other diseases regulated in the 

jurisdiction have received Regulatory/Health Authority approval to return to work.

1. No expired ingredients. Receiving date and rotation evident.

2. Only approved ingredient/chemicals evident.

3. All food, packaging, chemicals are properly stored to prevent cross contamination.

4. Cans are not dented or swollen.

5. Refrigerator food temperatures are less than or equal to 41°F.

6. Hot food temperatures are at least 135°F.

EQUIPMENT Y N COMMENTS / CORRECTIVE ACTION

FACILITIES INCLUDING STORAGE AREAS (basement, attics, sheds):

PEST ELIMINATION

EMPLOYEES

FOOD, PACKAGING AND SUPPLIES