§ 2-2. EMPLOYEE HEALTH

Subpart

2-201 Responsibilities and Reporting Symptoms and Diagnosis

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Responsibilities and Reporting Symptoms and Diagnosis	2-201.11	Responsibility of Licensee, Person in Charge, and Conditional Employees.*
	(A) The LICENSEE shall require FOOD EMPLOYEES and CONDITIONAL EMPLOYEES to report to the PERSON IN CHARGE information about their health and activities as they relate to diseases that are transmissible through FOOD. A FOOD EMPLOYEE or CONDITIONAL EMPLOYEE shall report the information in a manner that allows the PERSON IN CHARGE to reduce the RISK of foodborne disease transmission, including providing necessary additional information, such as the date of onset of symptoms and an illness, or of a diagnosis without symptoms, if the FOOD EMPLOYEE or CONDITIONAL EMPLOYEE:
reportable symptoms	(1) Has any of the following symptoms:
	(a) Vomiting,
	(b) Diarrhea,
	(c) Jaundice,
	(d) Sore throat with fever, or
	(e) A lesion containing pus such as a boil or infected wound that is open or draining and is:
	(i) On the hands or wrists, unless an impermeable cover such as a finger cot or stall protects the lesion and a SINGLE-USE glove is worn over the impermeable cover,
	(ii) On exposed portions of the arms, unless the lesion is protected by an impermeable cover, or
	(iii) On other parts of the body, unless the lesion is covered by a dry, durable, tight-fitting bandage;
reportable diagnosis	(2) Has an illness diagnosed by a HEALTH PRACTITIONER due to:
	(a) Norovirus,
	(b) Hepatitis A virus,
	(c) Shigella spp.,
	(d) ENTEROHEMORRHAGIC or SHIGA TOXIN-PRODUCING ESCHERICHIA COLI, or
	(e) Salmonella Typhi;
reportable past illness	(3) Had a previous illness, diagnosed by a HEALTH PRACTITIONER, within the past 3 months due to Salmonella Typhi, without having received antibiotic therapy, as determined by a HEALTH PRACTITIONER;
reportable history of exposure	(4) Has been exposed to, or is the suspected source of, a FOODBORNE DISEASE OUTBREAK, because the FOOD EMPLOYEE or CONDITIONAL EMPLOYEE consumed or prepared FOOD implicated in the outbreak, or consumed FOOD at an event prepared by a PERSON who is infected or ill with:
	(a) Norovirus within the past 48 hours of the last exposure,
	(b) ENTEROHEMORRHAGIC or SHIGA TOXIN-PRODUCING ESCHERICHIA COLI, or Shigella spp. within the past 3 days of the last exposure,
	(c) Salmonella Typhi within the past 14 days of the last exposure, or
	(d) Hepatitis A virus within the past 30 days of the last exposure; or
reportable history of exposure	(5) Has been exposed by attending or working in a setting where there is a FOODBORNE DISEASE OUTBREAK, or living in the same household as, and has knowledge about, an individual who works or attends a setting where there is a FOODBORNE DISEASE OUTBREAK, or living in the same household as, and has knowledge about, an individual diagnosed with an illness caused by:
	(a) Norovirus within the past 48 hours of the last exposure,
	(b) ENTEROHEMORRHAGIC or SHIGA TOXIN-PRODUCING ESCHERICHIA COLI, or Shigella spp. within the past 3 days of the last exposure,
	(c) Salmonella Typhi within the past 14 days of the last exposure, or
	(d) Hepatitis A virus within the past 30 days of the last exposure.
responsibility of person in charge to notify the regulatory authority
		(B) The PERSON IN CHARGE shall notify the REGULATORY AUTHORITY when a FOOD EMPLOYEE is:
	(1) Jaundiced, or
	(2) Diagnosed with an illness due to a pathogen as specified under Subparagraphs (A)(2)(a)—(e) of this section.
responsibility of the person in charge to prohibit a conditional employee from becoming a food employee	(C) The PERSON IN CHARGE shall ensure that a CONDITIONAL EMPLOYEE:
	(1) Who exhibits or reports a symptom, or who reports a diagnosed illness as specified under Subparagraphs (A)(1)—(3) of this section, is prohibited from becoming a FOOD EMPLOYEE until the CONDITIONAL EMPLOYEE meets the criteria for the specific symptoms or diagnosed illness as specified under § 2-201.13; and
	(2) Who will work as a FOOD EMPLOYEE in a FOOD ESTABLISHMENT that serves a HIGHLY SUSCEPTIBLE POPULATION and reports a history of exposure as specified under Subparagraphs (A)(4)—(5), is prohibited from becoming a FOOD EMPLOYEE until the CONDITIONAL EMPLOYEE meets the criteria as specified under ¶ 2-201.13(I).
responsibility of the person in charge to exclude or restrict	(D) The PERSON IN CHARGE shall ensure that a FOOD EMPLOYEE who exhibits or reports a symptom, or who reports a diagnosed illness or a history of exposure as specified under Subparagraphs (A)(1)—(5) of this section is:
	(1) EXCLUDED as specified under ¶¶ 2-201.12 (A)—(C), and Subparagraphs (D)(1), (E)(1), (F)(1), or (G)(1) and in compliance with the provisions specified under ¶¶ 2-201.13(A)—(G); or
	(2) RESTRICTED as specified under Subparagraphs 2-201.12 (D)(2), (E)(2), (F)(2), (G)(2), or ¶¶ 2-201.12(H) or (I) and in compliance with the provisions specified under ¶¶ 2-201.13(D)—(I).
responsibility of food employees and conditional employees to report	(E) A FOOD EMPLOYEE or CONDITIONAL EMPLOYEE shall report to the PERSON IN CHARGE the information as specified under ¶ (A) of this section.
responsibility of food employees to comply	(F) A FOOD EMPLOYEE shall:
	(1) Comply with an EXCLUSION as specified under ¶¶ 2-201.12(A) - (C) and Subparagraphs 2-201.12(D)(1), (E)(1), (F)(1), or (G)(1) and with the provisions specified under ¶¶ 2-201.13(A)—(G); or
	(2) Comply with a RESTRICTION as specified under Subparagraphs 2-201.12(D)(2), (E)(2), (F)(2), (G)(2), or ¶¶ 2-201.12 (H) or (I) and comply with the provisions specified under ¶¶ 2-201.13(D)—(I).
conditions of exclusion and restriction	2-201.12	Exclusions and Restrictions.*
	The PERSON IN CHARGE shall EXCLUDE or RESTRICT a FOOD EMPLOYEE from a FOOD ESTABLISHMENT in accordance with the following:
symptomatic with vomiting or diarrhea	(A) Except when the symptom is from a noninfectious condition, EXCLUDE a FOOD EMPLOYEE if the FOOD EMPLOYEE is:
	(1) Symptomatic with vomiting or diarrhea; or
	(2) Symptomatic with vomiting or diarrhea and diagnosed with an infection from Norovirus, Shigella spp., or ENTEROHEMORRHAGIC or SHIGA TOXIN-PRODUCING E. COLI.
jaundiced or diagnosed with hepatitis A infection	(B) EXCLUDE a FOOD EMPLOYEE who is:
	(1) Jaundiced and the onset of jaundice occurred within the last 7 calendar days, unless the FOOD EMPLOYEE provides to the PERSON IN CHARGE written medical documentation from a HEALTH PRACTITIONER specifying that the jaundice is not caused by hepatitis A virus or other fecal-orally transmitted infection;
	(2) Diagnosed with an infection from hepatitis A virus within 14 calendar days from the onset of any illness symptoms, or within 7 calendar days of the onset of jaundice; or
	(3) Diagnosed with an infection from hepatitis A virus without developing symptoms.
diagnosed or reported previous infection due to S. Typhi	(C) EXCLUDE a FOOD EMPLOYEE who is diagnosed with an infection from Salmonella Typhi, or reports a previous infection with Salmonella Typhi within the past 3 months as specified under Subparagraph 2-201.11(A)(3).
diagnosed with an asymptomatic infection from Norovirus	(D) If a FOOD EMPLOYEE is diagnosed with an infection from Norovirus and is ASYMPTOMATIC:
	(1) EXCLUDE the FOOD EMPLOYEE who works in a FOOD ESTABLISHMENT serving a HIGHLY SUSCEPTIBLE POPULATION; or
	(2) RESTRICT the FOOD EMPLOYEE who works in a FOOD ESTABLISHMENT not serving a HIGHLY SUSCEPTIBLE POPULATION.
diagnosed with Shigella spp. infection and asymptomatic	(E) If a FOOD EMPLOYEE is diagnosed with an infection from Shigella spp. and is ASYMPTOMATIC:
	(1) EXCLUDE the FOOD EMPLOYEE who works in a FOOD ESTABLISHMENT serving a HIGHLY SUSCEPTIBLE POPULATION; or
	(2) RESTRICT the FOOD EMPLOYEE who works in a FOOD ESTABLISHMENT not serving a HIGHLY SUSCEPTIBLE POPULATION.
diagnosed with EHEC or STEC and asymptomatic	(F) If a FOOD EMPLOYEE is diagnosed with an infection from ENTEROHEMORRHAGIC or SHIGA TOXIN-PRODUCING E. COLI, and is ASYMPTOMATIC:
	(1) EXCLUDE the FOOD EMPLOYEE who works in a FOOD ESTABLISHMENT serving a HIGHLY SUSCEPTIBLE POPULATION; or
	(2) RESTRICT the FOOD EMPLOYEE who works in a FOOD ESTABLISHMENT not serving a HIGHLY SUSCEPTIBLE POPULATION.
symptomatic with sore throat with fever	(G) If a FOOD EMPLOYEE is ill with symptoms of acute onset of sore throat with fever:
	(1) EXCLUDE the FOOD EMPLOYEE who works in a FOOD ESTABLISHMENT serving a HIGHLY SUSCEPTIBLE POPULATION; or
	(2) RESTRICT the FOOD EMPLOYEE who works in a FOOD ESTABLISHMENT not serving a HIGHLY SUSCEPTIBLE POPULATION.
symptomatic with uncovered infected wound or pustular boil	(H) If a FOOD EMPLOYEE is infected with a skin lesion containing pus such as a boil or infected wound that is open or draining and not properly covered as specified under Subparagraph 2-201.11(A)(1)(e), RESTRICT the FOOD EMPLOYEE.
exposed to foodborne pathogen and works in food establishment serving HSP	(I) If a FOOD EMPLOYEE is exposed to a foodborne pathogen as specified under Subparagraphs 2-201.11(A)(4) or (5), RESTRICT the FOOD EMPLOYEE who works in a FOOD ESTABLISHMENT serving a HIGHLY SUSCEPTIBLE POPULATION.
Managing Exclusions and Restrictions	2-201.13	Removal, Adjustment, or Retention of Exclusions and Restrictions.
	The PERSON IN CHARGE may remove, adjust, or retain the EXCLUSION or RESTRICTION of a FOOD EMPLOYEE according to the following conditions:
	(A) Except when a FOOD EMPLOYEE is diagnosed with an infection from hepatitis A virus or Salmonella Typhi:
removing exclusion for food employee who was symptomatic and not diagnosed	(1) Reinstate a FOOD EMPLOYEE who was EXCLUDED as specified under Subparagraph 2-201.12(A)(1) if the FOOD EMPLOYEE:
	(a) Is ASYMPTOMATIC for at least 24 hours; or
	(b) Provides to the PERSON IN CHARGE written medical documentation from a HEALTH PRACTITIONER that states the symptom is from a noninfectious condition.
Norovirus diagnosis
	(2) If a FOOD EMPLOYEE was diagnosed with an infection from Norovirus and EXCLUDED as specified under Subparagraph 2-201.12(A)(2):
adjusting exclusion for food employee who was symptomatic and is now asymptomatic	(a) RESTRICT the FOOD EMPLOYEE, who is ASYMPTOMATIC for at least 24 hours and works in a FOOD ESTABLISHMENT not serving a HIGHLY SUSCEPTIBLE POPULATION, until the conditions for reinstatement as specified under Subparagraphs (D)(1) or (2) of this section are met; or
retaining exclusion for food employee who was asymptomatic and is now asymptomatic and works in food establishment serving HSP	(b) Retain the EXCLUSION for the FOOD EMPLOYEE, who is ASYMPTOMATIC for at least 24 hours and works in a FOOD ESTABLISHMENT that serves a HIGHLY SUSCEPTIBLE POPULATION, until the conditions for reinstatement as specified under Subparagraphs (D)(1) or (2) of this section are met.
Shigella spp. diagnosis	(3) If a FOOD EMPLOYEE was diagnosed with an infection from Shigella spp. and EXCLUDED as specified under Subparagraph 2-201.12(A)(2):
adjusting exclusion for food employee who was symptomatic and is now asymptomatic	(a) RESTRICT the FOOD EMPLOYEE, who is ASYMPTOMATIC for at least 24 hours and works in a FOOD ESTABLISHMENT not serving a HIGHLY SUSCEPTIBLE POPULATION, until the conditions for reinstatement as specified under Subparagraphs (E)(1) or (2) of this section are met; or
retaining exclusion for food employee who was asymptomatic and is now asymptomatic	(b) Retain the EXCLUSION for the FOOD EMPLOYEE, who is ASYMPTOMATIC for at least 24 hours and works in a FOOD ESTABLISHMENT that serves a HIGHLY SUSCEPTIBLE POPULATION, until the conditions for reinstatement as specified under Subparagraphs (E)(1) or (2) , or (E)(1) and (3)(a) of this section are met.
EHEC or STEC diagnosis	(4) If a FOOD EMPLOYEE was diagnosed with an infection from ENTEROHEMORRHAGIC or SHIGA TOXIN-PRODUCING ESCHERICHIA COLI and EXCLUDED as specified under Subparagraph 2-201.12(A)(2):
adjusting exclusion for food employee who was symptomatic and is now asymptomatic	(a) RESTRICT the FOOD EMPLOYEE, who is ASYMPTOMATIC for at least 24 hours and works in a FOOD ESTABLISHMENT not serving a HIGHLY SUSCEPTIBLE POPULATION, until the conditions for reinstatement as specified under Subparagraphs (F)(1) or (2) of this section are met; or
retaining exclusion for food employee who was symptomatic and is now asymptomatic and works in food establishment serving HSP	(b) Retain the EXCLUSION for the FOOD EMPLOYEE, who is ASYMPTOMATIC for at least 24 hours and works in a FOOD ESTABLISHMENT that serves a HIGHLY SUSCEPTIBLE POPULATION, until the conditions for reinstatement as specified under Subparagraphs (F)(1) or (2) are met.
hepatitis A virus or jaundice diagnosis - removing exclusions	(B) Reinstate a FOOD EMPLOYEE who was EXCLUDED as specified under ¶ 2-201.12(B) if the PERSON IN CHARGE obtains APPROVAL from the REGULATORY AUTHORITY and one of the following conditions is met;
	(1) The FOOD EMPLOYEE has been jaundiced for more than 7 calendar days;
	(2) The anicteric FOOD EMPLOYEE has been symptomatic with symptoms other than jaundice for more than 14 calendar days; or
	(3) The FOOD EMPLOYEE provides to the PERSON IN CHARGE written medical documentation from a HEALTH PRACTITIONER stating that the FOOD EMPLOYEE is free of a hepatitis A virus infection.
S. Typhi diagnosis - removing exclusions	(C) Reinstate a FOOD EMPLOYEE who was EXCLUDED as specified under ¶ 2-201.12(C) if:
	(1) The PERSON IN CHARGE obtains APPROVAL from the REGULATORY AUTHORITY; and
	(2) The FOOD EMPLOYEE provides to the PERSON IN CHARGE written medical documentation from a HEALTH PRACTITIONER that states the FOOD EMPLOYEE is free from S. Typhi infection.
Norovirus diagnosis - removing exclusion or restriction	(D) Reinstate a FOOD EMPLOYEE who was EXCLUDED as specified under Subparagraphs 2-201.12(A)(2) or (D)(1) who was RESTRICTED under Subparagraph 2-201.12(D)(2) if the PERSON IN CHARGE obtains APPROVAL from the REGULATORY AUTHORITY and one of the following conditions is met:
	(1) The EXCLUDED or RESTRICTED FOOD EMPLOYEE provides to the PERSON IN CHARGE written medical documentation from a HEALTH PRACTITIONER stating that the FOOD EMPLOYEE is free of a Norovirus infection;
	(2) The FOOD EMPLOYEE was EXCLUDED or RESTRICTED after symptoms of vomiting or diarrhea resolved, and more than 48 hours have passed since the FOOD EMPLOYEE became ASYMPTOMATIC; or
	(3) The FOOD EMPLOYEE was EXCLUDED or RESTRICTED and did not develop symptoms and more than 48 hours have passed since the FOOD EMPLOYEE was diagnosed.
Shigella spp. diagnosis - removing exclusion or restriction	(E) Reinstate a FOOD EMPLOYEE who was EXCLUDED as specified under Subparagraphs 2-201.12(A)(2) or (E)(1) or who was RESTRICTED under Subparagraph 2-201.12(E)(2) if the PERSON IN CHARGE obtains APPROVAL from the REGULATORY AUTHORITY and one of the following conditions is met:
	(1) The EXCLUDED or RESTRICTED FOOD EMPLOYEE provides to the PERSON IN CHARGE written medical documentation from a HEALTH PRACTITIONER stating that the FOOD EMPLOYEE is free of a Shigella spp. infection based on test results showing 2 consecutive negative stool specimen cultures that are taken:
	(a) Not earlier than 48 hours after discontinuance of antibiotics, and
	(b) At least 24 hours apart;
	(2) The FOOD EMPLOYEE was EXCLUDED or RESTRICTED after symptoms of vomiting or diarrhea resolved, and more than 7 calendar days have passed since the FOOD EMPLOYEE became ASYMPTOMATIC; or
	(3) The FOOD EMPLOYEE was EXCLUDED or RESTRICTED and did not develop symptoms and more than 7 calendar days have passed since the FOOD EMPLOYEE was diagnosed.
EHEC or STEC diagnosis - removing exclusion or restriction	(F) Reinstate a FOOD EMPLOYEE who was EXCLUDED or RESTRICTED as specified under Subparagraphs 2-201.12(A)(2) or (F)(1) or who was RESTRICTED under Subparagraph2-201.12(F)(2) if the PERSON IN CHARGE obtains APPROVAL from the REGULATORY AUTHORITY and one of the following conditions is met:
	(1) The EXCLUDED or RESTRICTED FOOD EMPLOYEE provides to the PERSON IN CHARGE written medical documentation from a HEALTH PRACTITIONER stating that the FOOD EMPLOYEE is free of an infection from ENTEROHEMORRHAGIC or SHIGA TOXIN-PRODUCING ESCHERICHIA COLI based on test results that show 2 consecutive negative stool specimen cultures that are taken:
	(a) Not earlier than 48 hours after discontinuance of antibiotics; and
	(b) At least 24 hours apart;
	(2) The FOOD EMPLOYEE was EXCLUDED or RESTRICTED after symptoms of vomiting or diarrhea resolved and more than 7 calendar days have passed since the FOOD EMPLOYEE became ASYMPTOMATIC; or
	(3) The FOOD EMPLOYEE was EXCLUDED or RESTRICTED and did not develop symptomsand more than 7 days have passed since the FOOD EMPLOYEE was diagnosed.
sore throat with fever - removing exclusion or restriction	(G) Reinstate a FOOD EMPLOYEE who was EXCLUDED or RESTRICTED as specified under Subparagraphs 2-201.12(G)(1) or (2) if the FOOD EMPLOYEE provides to the PERSON IN CHARGE written medical documentation from a HEALTH PRACTITIONER stating that the FOOD EMPLOYEE meets one of the following conditions:
	(1) Has received antibiotic therapy for Streptococcus pyogenes infection for more than 24 hours;
	(2) Has at least one negative throat specimen culture for Streptococcus pyogenes infection; or
	(3) Is otherwise determined by a HEALTH PRACTITIONER to be free of a Streptococcus pyogenes infection.
uncovered infected wound or pustular boil - removing restriction	(H) Reinstate a FOOD EMPLOYEE who was RESTRICTED as specified under ¶ 2-201.12(H) if the skin, infected wound, cut, or pustular boil is properly covered with one of the following:
	(1) An impermeable cover such as a finger cot or stall and a single-use glove over the impermeable cover if the infected wound or pustular boil is on the hand, finger, or wrist;
	(2) An impermeable cover on the arm if the infected wound or pustular boil is on the arm; or
	(3) A dry, durable, tight-fitting bandage if the infected wound or pustular boil is on another part of the body.
exposure to foodborne pathogen and works in food establishment serving HSP - removing restriction	(I) Reinstate a FOOD EMPLOYEE who was RESTRICTED as specified under ¶ 2-201.12(I) and was exposed to one of the following pathogens as specified under Subparagraph2-201.11(A)(4) or (5):
Norovirus	(1) Norovirus and one of the following conditions is met:
	(a) More than 48 hours have passed since the last day the FOOD EMPLOYEE was potentially exposed; or
	(b) More than 48 hours have passed since the FOOD EMPLOYEE'S household contact became ASYMPTOMATIC.
Shigella spp., EHEC, or STEC	(2) Shigella spp. or ENTEROHEMORRHAGIC or SHIGA TOXIN- PRODUCING ESCHERICHIA COLI and one of the following conditions is met:
	(a) More than 3 calendar days have passed since the last day the FOOD EMPLOYEE was potentially exposed; or
	(b) More than 3 calendar days have passed since the FOOD EMPLOYEE'S household contact became ASYMPTOMATIC.
S. Typhi	(3) S. Typhi and one of the following conditions is met:
	(a) More than 14 calendar days have passed since the last day the FOOD EMPLOYEE was potentially exposed; or
	(b) More than 14 calendar days have passed since the FOOD EMPLOYEE'S household contact became ASYMPTOMATIC.
hepatitis A	(4) Hepatitis A virus and one of the following conditions is met:
	(a) The FOOD EMPLOYEE is immune to hepatitis A virus infection because of a prior illness from hepatitis A;
	(b) The FOOD EMPLOYEE is immune to hepatitis A virus infection because of vaccination against hepatitis A;
	(c) The FOOD EMPLOYEE is protected against to hepatitis A virus infection because of IgG administration;
	(d) More than 50 calendar days have passed since the last day the FOOD EMPLOYEE was potentially exposed;
	(e) More than 50 calendar days have passed since the FOOD EMPLOYEE'S household contact became jaundiced; or
	(f) The FOOD EMPLOYEE does not use an alternative procedure that allows bare hand contact with READY- TO-EAT FOOD until at least 50 days after the potential exposure, as specified in Subparagraphs (I)(4)(d) and
	(e) of this section, and the FOOD EMPLOYEE receives additional training about:
	(i) Hepatitis A symptoms and preventing the transmission of infection,
	(ii) Proper handwashing procedures, and
	(iii) Protecting READY-TO-EAT FOOD from contamination introduced by bare hand contact.

 

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