Employee Health Reporting Forms

The purpose of these Forms is to assist managers in preventing foodborne illness for the Organisms of Concern which transfer disease through food by infected employees.

Organisms of Concern:

1. Norovirus
2. Typhoid fever
3. Shigella ssp.
4. Shiga toxin-producing Escherichia coli (STEC)
5. Salmonella (nontyphoidal)
6. Hepatitis A Virus

Symptoms: diarrhea, vomiting, jaundice, sore throat with fever, infected cuts containing pus on an exposed body part

Exposure of Concern: Suspected of causing or being exposed to foodborne outbreaks involving an event (i.e. family meal, church supper or festival), lives with someone who has a foodborne diagnosis or an outbreak where they work.

Exclusion and Restriction: Considers the evidence about the person in an actual or potential foodborne illness transmission including symptoms, diagnosis, past illnesses and stool/blood test.

FDA Form 1-A: Interview

Management reviews employee’s past and current health conditions. If an employee has foodborne illness symptoms or exposed, the person in charge will take action to prevent the transmission of foodborne illness.

• FDA Form 1A: Interview

FDA Form 1-B: Agreement

Management informs employees of their responsibility to report future foodborne illness symptoms or medical diagnosis of actual foodborne illness of the above organisms of concern. In addition, employees must report if potentially exposed through a household member, event or other job.

• FDA Form 1B: Agreement
• FDA Form 1-B: Agreement (en espanol)

FDA Form 1-C: Medical Clearance

This form is designed to make sure someone who is suffering from foodborne illness symptoms or has a documented case of foodborne illness provides medical documentation or has met other alternative provisions to assure they do not come to work and potentially transmit foodborne illness.

• FDA Form 1C: Medical Clearance

Summary

In order to manage employee educational requirements (Certified Food Protection Manager, Food Handler Training and Allergy Awareness) and health tracking forms mentioned above a summary page has been created.

• Employee Educational & Health Tracking Summary Form

Certified Food Protection Manager

Illinois Department of Public Health (IDPH) Food Service Sanitation Manager Certification (FSSMC) was ELIMINATED. There are three different types of required training depending on your risk classification. High Risk is defined as potentially hazardous foods are cooked, cooled and reheated; Medium Risk handle hot and cold foods restricted to same-day service.

• IDPH will no longer charge $35 and issue a FSSMC license.
• The new approved Certified Food Protection Manager (CFPM) courses must be accredited by American National Standards Institute (ANSI).
• High Risk establishments require one CFPM at all times potentially hazardous foods are handled and one full-time staff member is necessary for Medium Risk facilities.
• Staff must be in compliance within 3 months after employment.
• Several approved course providers can be found on the ANSI website.
• CFPM certificates are valid for five years and the course must be taken again upon expiration.

Food Handler Training

• Food Handler Training is required for all staff that don’t hold CFPM certificates.
• Basic food handling principles are taught in this course which is approximately 90 minutes long.
• Food Handler Training certificates must be acquired within 30 days after employment and expire after three years.

Allergy Awareness Training

• Allergy Awareness Training is required for Certified Food Protection Managers to understand basic allergen awareness principles within 30 days after employment and every 3 years thereafter.
• This training is only required for High Risk establishments.
• "Non-restaurants" are exempt: i.e. grocery stores, convenience stores, daycares, schools, assisted living or long term care facilities.