1.2 Illness Reporting and Work Restrictions

A Sick Worker Is a Pathogen Source

Food employees who work while ill are a leading cause of foodborne-illness outbreaks. The FDA Food Code requires every operation to have a written employee health policy and a Person in Charge (PIC) who acts on it. The system has two parts: employees must report specific symptoms and diagnoses, and the PIC must then exclude or restrict that worker. Knowing which symptom triggers which action — and which diagnoses always require exclusion — is the heart of this topic and a guaranteed exam area.

The Five Reportable Symptoms

Food employees must tell the PIC if they have any of these five symptoms:

1. Vomiting
2. Diarrhea
3. Jaundice (yellowing of the skin or eyes)
4. Sore throat with fever
5. Infected wound or pus-filled lesion on the hand, wrist, or exposed body part

Vomiting, diarrhea, and jaundice are the most serious because they signal an actively contagious gastrointestinal infection. Jaundice in particular is associated with Hepatitis A and triggers strict handling. A worker with jaundice for 7 days or less must be excluded, and the regulatory authority and a doctor become involved.

The "Big 6" Reportable Diagnoses

Beyond symptoms, employees must report a diagnosis of any of these six pathogens — even with no symptoms, because people can be asymptomatic carriers (shedders):

Exam note: The first five (Norovirus, Hepatitis A, Salmonella Typhi, Shigella, STEC) are sometimes called the "Big 5," and adding nontyphoidal Salmonella makes the "Big 6." If a question lists six, all six are reportable diagnoses requiring action.

Exclude vs. Restrict

The two actions are not interchangeable, and mixing them up is a classic wrong answer.

The action also depends on who is served. Operations serving a Highly Susceptible Population (HSP) — young children/preschoolers, older adults in care facilities, and immunocompromised people — apply stricter rules. For example, a worker with a sore throat and fever is restricted in a normal restaurant but excluded when serving an HSP, and asymptomatic carriers of STEC or Shigella are excluded from HSP settings.

Returning to Work

A worker who was excluded cannot simply feel better and return; the Food Code sets specific clearance rules.

Covering Wounds

A cut or burn on the hand or wrist is an infection risk. The worker must clean the wound, cover it with a waterproof bandage, and wear a single-use glove or finger cot over it before handling food. An infected wound (pus, redness, swelling) is a reportable symptom and means the worker is restricted or excluded until it heals. The guiding principle: honest reporting protects customers, and missing one shift is always better than causing an outbreak.

How the System Flows

Trace a typical scenario to lock in the logic. A line cook wakes up with diarrhea and tells the manager (the PIC). Because diarrhea is one of the five reportable symptoms and is an exclusion trigger, the cook is sent home and does not work — not even on packaged items or dishwashing. The cook may return after being symptom-free for 24 hours or with a doctor's written release. Now change the facts: the cook is later diagnosed with Norovirus. That is one of the Big 6 diagnoses, so the exclusion now requires clearance from the regulatory authority before return, a higher bar than the simple 24-hour symptom rule.

Change them again: the operation is a nursing home (a highly susceptible population). Conditions that would only restrict a worker elsewhere — like sore throat with fever — now require exclusion, because the customers are far more vulnerable to infection.

The takeaway for the exam: first ask what the worker has (symptom vs. diagnosis), then ask who is served (general public vs. HSP), and the correct exclude/restrict answer follows. A written employee health policy and a PIC who enforces it are what turn these rules into real protection.