3.3 Policies for Reporting Illness and Injury

When food handlers are sick, they can spread pathogens to food and cause outbreaks. The FDA Food Code requires strict policies for reporting illness, excluding or restricting ill employees, and documenting when staff can safely return to work.

This section is HEAVILY TESTED on the ServSafe exam. You must know when to exclude vs. restrict employees, the Big Six pathogens, and symptoms requiring notification.

The Big Six Pathogens

The Big Six are highly contagious foodborne pathogens that require special exclusion policies. When employees are diagnosed with or suspected of having one of these illnesses, managers must take immediate action.

The Big Six Pathogens:

For the Exam: Memorize the Big Six. You WILL be tested on which pathogens require exclusion and when employees can return to work.

Why the Big Six require special attention:

• Highly infective - Small amounts cause illness
• Easily transmitted - Spread through fecal-oral route
• Severe illness - Can cause hospitalization or death
• Asymptomatic carriers - People can spread disease without feeling sick

Symptoms Requiring Manager Notification

Food handlers MUST immediately notify the person in charge (manager) if they have any of these symptoms:

Additional reporting requirements:

• Diagnosed with one of the Big Six pathogens
• Exposed to someone with one of the Big Six
• Recent travel to countries with high rates of Typhoid or Hepatitis A

For the Exam: Know these five symptoms cold. Many questions ask "A food handler reports [symptom]. What must the manager do?"

Exclude vs. Restrict: Critical Differences

Understanding when to exclude vs. restrict is essential for the exam.

Exclusion

Exclusion means the employee is NOT allowed to enter or work in the food establishment at all.

When to EXCLUDE:

High-risk populations include:

• Hospitals and nursing homes
• Daycare centers
• Senior living facilities
• Schools with young children (under 5)

Key Point: If serving high-risk populations, policies are MORE STRICT. Exclusion is required in more situations.

Restriction

Restriction means the employee can work in the establishment but is restricted from:

• Working with or around food
• Working with clean equipment, utensils, or linens
• Touching food-contact surfaces

What restricted employees CAN do:

• Host/greet customers
• Take orders
• Handle money
• Bus tables (but not clean dishes)
• Janitorial work (not in food prep areas)

When to RESTRICT:

For the Exam: If a question asks about excluding or restricting, consider: (1) What is the symptom/diagnosis? (2) What population is being served?

Comprehensive Exclude vs. Restrict Table

Use this table to determine the correct action for different scenarios:

For the Exam: This table format appears frequently. You'll see scenarios like "A food handler working in a nursing home has vomiting. What action must the manager take?" Answer: Exclude immediately.

When Food Handlers Can Return to Work

General Rules:

After exclusion for vomiting/diarrhea:

• Must be symptom-free for at least 24 hours (no medications masking symptoms)
• Must obtain written medical clearance from healthcare provider
• Manager must document return-to-work approval

After exclusion for Big Six diagnosis:

• Must obtain written medical clearance or negative stool samples (number varies by pathogen)
• Must meet health department requirements
• May require multiple negative tests spaced days apart

After exclusion for jaundice:

• Must obtain clearance from local health department
• Typically requires 7 days symptom-free after jaundice appears
• Hepatitis A vaccination may be required for other staff

After restriction:

• Sore throat with fever: 24 hours fever-free without medication
• Infected wound: Wound fully healed or medical clearance stating not contagious

Critical: Never allow employees to return to work based on their word alone. Require written documentation from a healthcare provider or health department.

Documentation Requirements

Managers must maintain records of:

Employee illness reporting:

• Date and time employee reported symptom/diagnosis
• Specific symptom or diagnosis reported
• Action taken (exclude or restrict)
• Date cleared to return to work
• Medical documentation received

Training records:

• Proof employees were trained on illness reporting policies
• Signed acknowledgment that employees understand requirements
• Annual refresher training documentation

Health department notification:

• When required, document date and method of health department notification
• Copy of health department guidance or clearance

Creating a Culture of Reporting

Many employees hesitate to report illness because they fear losing income or their job. As a manager, you must:

Encourage reporting:

• Make it easy and confidential
• Never punish employees for reporting illness
• Emphasize that staying home protects customers and coworkers

Provide incentives:

• Sick leave policies that don't penalize ill employees
• Cross-training so shifts can be covered
• Recognition for employees who follow policies

Train thoroughly:

• Explain WHY illness policies exist (not just the rules)
• Use real outbreak examples to demonstrate consequences
• Review policies during onboarding and annually

Lead by example:

• Managers must also report illness and stay home when sick
• Never pressure sick employees to work
• Respond promptly and professionally when illness is reported

Preventing Illness in the Workplace

Beyond exclusion and restriction, managers should:

Vaccination programs:

• Encourage or require Hepatitis A vaccination for all food handlers
• Provide annual flu shots
• Educate about vaccine-preventable diseases

Workplace hygiene:

• Enforce handwashing policies strictly
• Provide adequate sick leave
• Maintain clean restrooms and break areas
• Encourage employees to get medical care when ill

Monitoring:

• Observe employees for signs of illness daily
• Ask screening questions at start of shifts
• Watch for employees who appear unwell but don't report

For the Exam: This section is critical. Expect 5+ questions on exclude vs. restrict scenarios, Big Six pathogens, symptoms requiring action, and when employees can return to work.