Hepatitis A. Note: The manager must report to the Health Department when an employee has one of these illnesses.
1. An outbreak of Norovirus, typhoid fever, Shigella spp. infection, E. coli infection, or Hepatitis A.
2. A household member with Norovirus, typhoid fever, Shigella spp. infection, E. coli infection, or hepatitis A.
3. A household member attending or working in a setting with an outbreak of Norovirus, typhoid fever, Shigella spp. infection, E. coli infection, or Hepatitis A.
Hepatitis A a. No routine screening or vaccination offered at pre-employment. .
Hepatitis A. Note: The manager must report to the Health Department when an employee has one of these illnesses. Reporting: Exposure of Illness I agree to report to the manager when I have been exposed to any of the illnesses listed above through:
1. An outbreak of Norovirus, typhoid fever, Shigella spp. infection, E. coli infection, or Hepatitis A.
2. A household member with Norovirus, typhoid fever, Shigella spp. infection, E. coli infection, or hepatitis A.
3. A household member attending or working in a setting with an outbreak of Norovirus, typhoid fever, Shigella spp. infection, E. coli infection, or Hepatitis A. Exclusion and Restriction from Work If you have any of the symptoms or illnesses listed above, you may be excluded* or restricted** from work. *If you are excluded from work you are not allowed to come to work. **If you are restricted from work you are allowed to come to work, but your duties may be limited. Returning to Work If you are excluded from work for having diarrhea andƒor vomiting, you will not be able to return to work until more than 24 hours have passed since your last symptoms of diarrhea andƒor vomiting. If you are excluded from work for exhibiting symptoms of a sore throat with fever or for having jaundice (yellowing of the skin andƒ or eyes), Norovirus, Salmonella Typhii (typhoid fever), Shigella spp. infection, E. coli infection, andƒor Hepatitis A, you will not be able to return to work until Health Department approval is granted. Agreement I understand that I must:
1. Report when I have or have been exposed to any of the symptoms or illnesses listed above; and
2. Comply with work restrictions andƒor exclusions that are given to me. I understand that if I do not comply with this agreement, it may put my job at risk. Food Employee Name (please print) Signature of Employee Date Manager (Person-in-Charge) Name (please print) Signature of Manager (Person-in-Charge) Date These are some of the Bacterium and Viruses spread from Food Handlers to Food
E. Coli Shigella
1. Handwashing is the MOST CRITICAL control step in prevention of disease Invest 20 seconds to follow these 6 simple steps: 1. Wet your hands and arms with warm running water. 2. Apply soap and bring to a good lather.
3. Scrub hands and arms vigorously for 10 to 15 seconds (clean under nails and between fingers). 4. Rinse hands and arms thoroughly under running water. 5. Dry hands and arms with a single-use paper towel or warm-air hand dryer.
6. Use the towel to turn off faucets a...
Hepatitis A. Yes No Yes No Yes No Letting employees make up shifts Yes No Yes No Yes No Other: Yes No Yes No Yes No Other: Yes No Yes No Yes No Other: Yes No Yes No Yes No Have these practices changed since January 2020? (Only ask on initial visit) Yes No Unsure Refused If No → go to question 24 Have any of the following practices changed? Practice changed: If practice changed, Is practice new? If practice is not new/has changed: Is it stricter or more lenient? What/how has it changed? Comments: How you operate when an employee calls in sick Yes No (If no, go to #2) Not new New (If New, go to #2) Stricter More lenient Check all that apply ☐ Work short staffed ☐ Depends on how sick ☐ Other Any practices that you have implemented to keep sick workers from working Yes No (If no, go to #3) Not new New (If New, go to #3) Stricter More lenient Check all that apply ☐ Emp arrange coverage ☐ Manager arrange coverage ☐ Have on call ☐ Paid sick leave ☐ Employer subsidized immunizations ☐ Make up shifts ☐ Other Any other practices I haven’t mentioned changed? Yes No -- -- -- -- What changed? Describe: -- Not new New (If New, go to #b) Stricter More lenient Describe change: What changed? Describe: -- Not new New Stricter More lenient Describe change: In your opinion, if this restaurant were to adopt a practice to keep sick workers from working, which of the following practices would most likely be adopted by this restaurant? If practice is already occurring check the already occurring box and do not read that answer choice.
a. Paid sick leave or additional paid sick leave if you already provide sick leave Would adopt Already occurring Unsure
b. Maintaining an on-call employee schedule Would adopt Already occurring Unsure
c. Paying for employee immunizations Would adopt Already occurring Unsure
d. Allowing employees to make up missed shifts Would adopt Already occurring Unsure
e. Or are there other provisions that you would consider Would adopt Already occurring Unsure
f. Are there any others the restaurant might adopt? Describe: Yes No Unsure None Unsure Refused Who in the restaurant would be able to make changes to this restaurant’s ill worker policy? (Check all that apply) ☐ Owner ☐ General manager ☐ Corporate office ☐ Other: __________________________________ ☐ Unsure ☐ Refused This is the person being interviewed Yes-writt...
Hepatitis A. Note: The permit holder/operator/PIC must report to the Health Department when an employee has one of these illnesses.
1. Norovirus within the past 48 hours of the last exposure,
2. Typhoid fever within the past 14 days of the last exposure,
3. Shigella spp. infection within the past 3 days of the last exposure,
4. E. Coli infection within the past 3 days of the last exposure,
Hepatitis A. Note: The manager must report to the Health Department when an employee has been diagnosed with one of these illnesses.
