Food Employee Reporting Agreement

10 Food Employee Reporting Agreement Reporting Symptoms of Illness I agree to report to the Person in Charge PIC when I have 1 Diarrhea 2 Vomiting 3 Jaundice yellowing of the skin and or eyes 4 Sore throat with fever 5 Infected cuts or wounds , or lesions containing pus on the hand , wrist , an exposed body part such as boils and infected wounds , however small Note The PIC must report to the Health Department when an employee is jaundiced Reporting Diagnosed Illnesses I agree to report to the Person in Charge PIC when I have been diagnosed with 1 Norovirus 2 Hepatitis A virus 3 Shigella spp infection shigellosis 4 Shiga Toxin - Producing Escherichia coli O157 H7 or other STEC infection 5 Typhoid fever caused by Salmonella Typhi 6 Salmonella nontyphoidal Note The PIC must report to the Health Department when an employee has one of these illnesses Reporting Exposure of Illness I agree to report to the PIC when I have been exposed to any of the illnesses listed above through 1 An outbreak of Norovirus , typhoid fever , shigellosis , E coli O157 H7 or other STEC infection , or Hepatitis A 2 A household member with Norovirus , typhoid fever , shigellosis , illness due to STEC , or Hepatitis A 3 A household member attending or working in a setting experiencing a confirmed outbreak of Norovirus , typhoid fever , shigellosis , E coli O157 H7 or other STEC 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 and or vomiting , you will not be able to return to work until 1 more than 24 hours have passed since your last symptoms of diarrhea and or vomiting , or 2 provide written medical documentation from a health practitioner indicating that the symptoms are from a noninfectious condition If you are excluded from work for exhibiting symptoms of Norovirus , Salmonella Typhi , nontyphoidal Salmonella , Shigella spp infection , E coli O157 H7 or other STEC infection , and or Hepatitis A , you will not be able to return to work until approval from the Health Department is granted I have read or had explained to me and understand the requirements concerning my responsibilities under the Food Code and this agreement to comply with 1 Reporting requirements specified above involving symptoms , diagnoses , and exposure specified ; 2 Work restrictions or exclusions that are imposed upon me ; and 3 Good hygienic practices I understand that failure to comply with the terms of this agreement could lead to action by the food establishment or the fo od Regulatory Authority that may jeopardize my employment and may involve legal action against me Employee Name please print _______________________ Signature of Employee _______________________ Date ___________ PIC Name please print _____________________________ Signature of PIC ____________________________ Date ___________PageE Coli Overview A bacterium that can produce a deadly toxin and causes an estimated 70,000 cases of foodborne illnesses each year in the US Sources Meat , especially undercooked or raw hamburger , produce and raw milk Incubation period 2 - 10 days Symptoms Severe diarrhea , cramping , dehydration Prevention Cook implicated food to 155F , wash hands properly and frequently , correctly wash rinse and sanitize food contact surfaces Shigella Overview Shigella is a bacterium that causes an estimated 450,000 cases of diarrhea illnesses each year Poor hygiene causes Shigella to be easily passed from person to person Sources Salad , milk , dairy products , and unclean water Incubation period 1 - 7 days Symptoms Diarrhea , stomach cramps , fever , chills and dehydration Prevention Wash hands properly and frequently , especially after using the restroom , wash vegetables thoroughly Salmonella nontyphoidal Overview Salmonella is a bacterium responsible for millions of cases of foodborne illnesses a year The elderly , infants , and individuals with impaired immune systems are at risk for severe illness Death can occur if the person is not treated promptly with antibiotics Sources Raw and undercooked eggs , undercooked poultry and meat , dairy products , seafood , fruits and vegetables Incubation period 5 - 72 hours up to 16 days has been documented for low doses Symptoms Nausea , vomiting , cramps , and fever Prevention Cook all food to proper temperatures , chill food rapidly , and eliminate sources of cross - contamination ie proper meat storage , proper washing , rinsing , and sanitizing procedures Salmonella Typhi Typhoid fever Overview Salmonella Typhi is the bacterium that causes Typhoid fever and is responsible for an estimated 430 cases each year This illness is caused by eating or drinking food or water contaminated with feces from an infected person Incubation period Generally 1 to 3 weeks , but may be as long as 2 months after exposure Sources Ready to eat food , water , and beverages Symptoms High fever , from 103 ° F to 104 ° F ; lethargy ; gastrointestinal symptoms , including abdominal pains and diarrhea or constipation ; headache ; achiness ; loss of appetite A rash of flat , rose - colored spots sometimes occurs Symptoms typically last 2 to 4 weeks Prevention E xcluding sick food workers , practicing good personal hygiene , preventing cross - contamination , and cooking food to the required final cook temperatures Hepatitis A Overview Hepatitis A is a liver disease caused by the Hepatitis A virus Hepatitis A can affect anyone In the United States , Hepatitis A can occur in situations ranging from isolated cases of disease to widespread epidemics Incubation period 15 - 50 days Symptoms Jaundice , nausea , diarrhea , fever , fatigue , loss of appetite , cramps Prevention Wash hands properly and frequently , especially after using the restroom Norovirus Overview This virus is the leading cause of diarrhea in the United States Any food can be contaminated with norovirus if handled by someone who is infected with the virus This virus is highly infectious Incubation period 6 - 48 hours Symptoms Nausea , vomiting , diarrhea , and cramps Prevention Wash hands properly and frequently , especially after using the restroom obtain food from a reputable food source and wash vegetables thoroughly Common Foodborne Illnesses 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 and open door handles so you don't re - contaminate your hands 2 Don't go to work when you are sick 3 No bare hand contact with ready - to - eat foods Prevention of Contamination by HandsPage