7.1 Symptoms and Reporting Responsibilities
Key Takeaways
- Food employees and conditional employees must report vomiting, diarrhea, jaundice, sore throat with fever, and uncovered infected wounds or pustular lesions on hands, wrists, or other exposed areas.
- They must also report Big Six diagnoses, a Salmonella Typhi history in the last three months, and certain exposures — especially in facilities serving a highly susceptible population.
- The Person in Charge notifies the Regulatory Authority when an employee has jaundice or a diagnosed Big Six illness.
- A conditional employee is an applicant or new hire not yet working with food; a Form 1-B-style agreement is a common training tool, not a nationwide mandate.
- Never work while vomiting or having diarrhea — “I feel fine now” is not a return-to-work decision.
FDA Food Code 2-201.11 is the employee-health reporting rule. It is not a human-resources courtesy and it is not optional on a short-staffed Saturday. A food employee who hides vomiting, diarrhea, jaundice, or a Big Six diagnosis can contaminate ready-to-eat (RTE) food, clean utensils, and every handle between the restroom and the pass. The Person in Charge (PIC) is the person the Code charges with collecting that information and acting on it.
Chapter 3 named the Big Six. Chapter 6 showed how hands move those organisms onto food. This chapter is the control that starts before anyone reaches for soap: who must speak, what they must say, and whom the PIC must call.
Who Must Report, and Who Is a Conditional Employee
Food employees already work with food, utensils, linens, or food-contact surfaces. Conditional employees are applicants or new hires who have a job offer that is still conditional on medical or reporting questions, and who are not yet working as food employees. Both groups have the same reporting duty. The PIC may not put a conditional employee onto the line until that person meets the same health criteria a current food employee would have to meet. A new hire who admits last night’s vomiting does not “start on salads and we’ll see.”
Many operations use a Form 1-B-style reporting agreement from the Food Code annex. It is a common training tool: the employee signs that they understand which symptoms, diagnoses, and exposures they must tell the PIC. Do not claim the form is required in every jurisdiction. Local codes vary. The reporting duty in 2-201.11 is what the exam tests, not the stationery.
Employees must give the PIC enough detail to act, including date of onset when they have symptoms or a diagnosis. “I was kind of sick last week” is not a report.
The Five Symptoms That Must Be Reported
A food employee or conditional employee must report each of the following to the PIC:
- Vomiting
- Diarrhea
- Jaundice (yellowing of the skin or eyes)
- Sore throat with fever
- An uncovered infected wound or pustular lesion (a boil, draining cut, or similar) on the hands or wrists, or on other exposed portions of the arms or body
The wound item is specific. A pus-filled lesion on a hand or wrist that is not covered by an impermeable barrier plus a single-use glove is a reportable condition. A draining boil on an exposed forearm is reportable. A covered lesion under clothing is treated differently because it is not an exposed, uncovered source.
These five are symptoms, not laboratory names. The employee does not wait for a stool test before telling the PIC. Vomiting is enough. Diarrhea is enough. Jaundice is enough. The PIC then excludes or restricts under 2-201.12 and, when the Code requires it, notifies the Regulatory Authority.
Do not invent extra reportable symptoms. A headache, a runny nose without fever, or ordinary muscle aches are not 2-201.11 symptoms by themselves. Sore throat with fever is the strep-pattern item. Sore throat alone is not the same box.
Never Work While Vomiting or Having Diarrhea
This is the brightest rule in the chapter. A food employee who is vomiting or has diarrhea does not stay on the line, does not “just plate salads with gloves,” and does not move to the dish machine for the rest of the rush. Exclude. The person leaves the establishment. Antidiarrheal medicine, a short nap, or “I feel fine now” does not restart the shift.
Why the rule is absolute: norovirus, Shigella, STEC, hepatitis A virus, and both salmonellae can leave the gut on hands and droplets. A single episode of diarrhea can leave a high load on skin, clothing, and restroom surfaces. RTE food will not get a later cook step that erases that dose.
Diagnoses and Exposures That Must Be Reported
Employees must also report a health-practitioner diagnosis of any Big Six pathogen:
- Norovirus
- Hepatitis A virus
- Shigella spp.
- Shiga toxin-producing Escherichia coli (STEC)
- Salmonella Typhi (typhoid fever)
- Nontyphoidal Salmonella (NTS)
They must report the diagnosis whether or not they still feel sick. An asymptomatic typhoid carrier is still a reporting event.
They must also report a previous Salmonella Typhi illness in the last three months when they did not receive antibiotic therapy as determined by a health practitioner. That history is how the Code catches recent typhoid that can still shed.
Exposures are the third reporting bucket, and they matter most in facilities serving a highly susceptible population (HSP) — hospitals, nursing homes, daycare, and similar settings. Reportable exposures include consuming or preparing food implicated in a confirmed outbreak, attending or working in a setting with a confirmed outbreak, or living with a household member who has a diagnosed illness or who works in an outbreak setting. The Code uses look-back windows that differ by organism (norovirus is short; hepatitis A is much longer). CFPM exams usually test that exposures are reportable, especially in HSP facilities, not that you have memorized every hour count.
What the PIC Must Tell the Regulatory Authority
The employee reports to the PIC. The PIC reports to the Regulatory Authority (RA) — the local or state health department that issued the permit — when a food employee has:
- Jaundice, or
- A diagnosed Big Six illness
Certain other conditions in a local code can trigger the same call. The exam-stable pair is jaundice and Big Six diagnosis. The PIC does not wait until Monday. The PIC does not “see if it fades.” The employee does not call the health department instead of telling the manager. Form 1-B is not mailed to FDA as a substitute for that notification.
Who Tells Whom
| What is going on | Who reports it | To whom | What the PIC does next |
|---|---|---|---|
| Vomiting or diarrhea | Food employee or conditional employee | PIC | Exclude immediately; do not wait for a lab name |
| Jaundice | Food employee or conditional employee | PIC | Exclude and notify the Regulatory Authority |
| Sore throat with fever | Food employee or conditional employee | PIC | Restrict in a non-HSP operation; exclude in an HSP operation |
| Uncovered infected wound or pustular lesion on hands, wrists, or other exposed skin | Food employee or conditional employee | PIC | Restrict until the lesion is properly covered |
| Diagnosed Big Six illness | Food employee or conditional employee | PIC | Generally exclude and notify the RA |
| Recent typhoid (S. Typhi) in the last 3 months | Food employee or conditional employee | PIC | Treat as a reportable history; involve the RA as the Code requires |
| Certain outbreak or household exposures, especially in HSP facilities | Food employee or conditional employee | PIC | Apply the 2-201.12 restriction or exclusion for that exposure |
| Conditional employee with any of the above, before the first shift | Applicant / new hire | PIC | Do not allow that person to become a food employee until return-to-work criteria are met |
Scenario: The Line Cook Who “Feels Fine Now”
A Saturday brunch cook had diarrhea at 6:00 a.m. He took an over-the-counter stopper, showered, and arrived at 9:30. He tells the PIC, “It was just something I ate. I feel fine now. I can glove up and plate the smoked-salmon toast.”
This is not a glove problem and it is not a “feels fine” problem. Diarrhea was reported. The Food Code answer is exclusion. The cook leaves the establishment. He does not plate RTE salmon. He does not run the dish machine. He does not stand in the kitchen “just to help on tickets.” The PIC documents the report, including onset time, and starts the return-to-work clock in 2-201.13 (typically at least 24 hours symptom-free when there is no Big Six diagnosis). If a laboratory later names norovirus or STEC, the PIC notifies the RA and the longer reinstatement rules apply.
The exam trap is sympathy. The cook is short-staffed. The toast is already on the board. Gloves feel like a control. None of that overrides 2-201.11. Reporting only works if the PIC treats a report as an action, not as a conversation.
What CFPM Exams Typically Test
Provider courses flatten 2-201.11 into a memorable list: five symptoms, Big Six diagnoses, certain exposures, PIC notifies the RA for jaundice or a Big Six diagnosis, conditional employees report too, never work with vomiting or diarrhea. Local health departments can add forms, phone numbers, or extra reportable conditions. Those local extras are not a national exam key. When a stem gives you a line cook with diarrhea who wants to stay, you exclude. When a stem gives you jaundice, you exclude and call the RA. When a stem gives you a new hire who admits last night’s vomiting, you do not put that conditional employee on the salad station.
A line cook had diarrhea at 6:00 a.m., took medicine, and now says he feels fine and can glove up to plate smoked-salmon toast. What must the PIC do?
Which statement correctly describes what food employees and conditional employees must report to the PIC under Food Code 2-201.11?
When must the Person in Charge notify the Regulatory Authority?