3.3 Policies for Reporting Illness and Injury

ServSafe Food Protection Manager Certification Exam

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1 Introduction

Welcome to ServSafe Manager Certification

2 1. Providing Safe Food

1.1 Understanding Foodborne Illnesses 1.2 How Foodborne Illnesses Occur 1.3 Keeping Food Safe

3 2. Forms of Contamination

2.1 Biological Contaminants 2.2 Chemical and Physical Contaminants 2.3 Food Allergens 2.4 Deliberate Contamination and Outbreak Response

4 3. The Safe Food Handler

3.1 How Food Handlers Can Contaminate Food 3.2 Personal Hygiene Program 3.3 Policies for Reporting Illness and Injury

5 4. The Flow of Food: An Introduction

4.1 Hazards in the Flow of Food 4.2 Monitoring Time and Temperature

6 5. The Flow of Food: Purchasing, Receiving, and Storage

5.1 General Purchasing and Receiving Principles 5.2 Storing Food Safely

7 6. The Flow of Food: Preparation

6.1 Preparation Best Practices 6.2 Cooking Food to Safe Temperatures 6.3 Cooling and Reheating Food

8 7. The Flow of Food: Service

7.1 Holding Food for Service 7.2 Serving Food Safely

9 8. Food Safety Management Systems

8.1 Active Managerial Control and HACCP

10 9. Safe Facilities and Pest Management

9.1 Interior Design and Equipment Requirements 9.2 Utilities and Emergency Planning 9.3 Pest Management

11 10. Cleaning and Sanitizing

10.1 Cleaning and Sanitizing Principles 10.2 Chemical Sanitizers - CRITICAL! 10.3 Dishwashing 10.4 Facility Cleaning

3.3 Policies for Reporting Illness and Injury

Key Takeaways Explain This Topic AI

The Big Six pathogens require exclusion: Norovirus, Hepatitis A, Salmonella Typhi, Nontyphoidal Salmonella, Shigella, and Shiga toxin-producing E. coli

EXCLUDE immediately for: vomiting, diarrhea, jaundice (within 7 days), or Big Six diagnosis

RESTRICT for: sore throat with fever (general population), infected wound on hands/wrists, or Big Six exposure without symptoms

Exclusion = cannot enter establishment; Restriction = can work but not with food/clean equipment

Food handlers can return after 24 hours symptom-free AND written medical clearance

High-risk populations (hospitals, nursing homes, daycare) require STRICTER exclusion policies

Create a culture where employees feel safe reporting illness without fear of punishment
Last updated: January 2026

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:

Pathogen Illness Name Key Facts

1. Norovirus Norovirus infection Most common cause of foodborne illness; highly contagious; spreads through vomit and feces

2. Hepatitis A Hepatitis A Liver infection; spreads fecal-oral route; vaccine-preventable

3. Salmonella Typhi Typhoid fever Severe illness; spreads through feces; person can be carrier without symptoms

4. Nontyphoidal Salmonella Salmonellosis Common in raw poultry/eggs; causes severe diarrhea and fever
5. Shigella spp. Shigellosis Severe bloody diarrhea; highly contagious; spreads fecal-oral

6. Shiga toxin-producing E. coli (STEC) E. coli infection Includes E. coli O157:H7; causes severe bloody diarrhea; can lead to kidney failure

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:

Symptom Why It Matters Action Required
Vomiting Sign of Norovirus, Hepatitis A, or other infection Exclude immediately
Diarrhea Sign of Big Six pathogens (Salmonella, Shigella, E. coli) Exclude immediately

Jaundice (yellowing of skin/eyes) Sign of Hepatitis A (liver infection) Exclude immediately; notify health department

Sore throat with fever Sign of Streptococcus (Strep throat) Restrict or exclude depending on population served

Infected wound/boil with pus Staphylococcus aureus causes staph food poisoning Restrict unless on hands/wrists—then exclude

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:

Situation Why Duration
Vomiting or diarrhea Active shedding of pathogens Until 24 hours symptom-free + medical clearance
Jaundice (appeared within 7 days) Sign of Hepatitis A Until health department/medical clearance
Diagnosed with Big Six pathogen Highly contagious Until medical clearance + symptom-free
Sore throat with fever (serving high-risk population) Strep can contaminate food Until medical clearance

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:

Situation Why Duration
Sore throat with fever (general population) Potential Strep contamination Until 24 hours symptom-free
Infected wound on hand/wrist with pus Staph aureus sheds into food Until wound heals or medical clearance

Recent exposure to Big Six (no symptoms) Possible asymptomatic carrier Until tested negative or symptom-free period passes

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

Loading diagram... Exclude vs. Restrict Decision Flowchart

Comprehensive Exclude vs. Restrict Table

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

Condition High-Risk Population General Population When Can Return
Vomiting Exclude Exclude 24 hours symptom-free + medical clearance
Diarrhea Exclude Exclude 24 hours symptom-free + medical clearance
Jaundice (within 7 days) Exclude Exclude Health department/medical clearance
Diagnosed: Norovirus Exclude Exclude 24 hours symptom-free + written medical clearance
Diagnosed: Hepatitis A Exclude Exclude Health department clearance + jaundice resolved
Diagnosed: Salmonella Typhi Exclude Exclude Three consecutive negative stool samples
Diagnosed: Shigella Exclude Exclude Written medical clearance + symptom-free
Diagnosed: E. coli (STEC) Exclude Exclude Two consecutive negative stool samples
Diagnosed: Salmonella (nontyphoidal) Exclude Exclude Written medical clearance + symptom-free
Sore throat with fever Exclude Restrict Written medical clearance (or 24 hrs symptom-free for restriction)
Infected wound (hands/wrists) Exclude or restrict Restrict Wound heals or medical clearance
Exposed to Big Six (no symptoms) Restrict Restrict Negative test or monitoring period complete

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.