Illness Reporting
Foodborne illness can spread silently from one sick employee to dozens of customers in a single shift. California's Retail Food Code, like the FDA Food Code it is built on, treats employee health as a public-health issue and not a personal one. This chapter walks through what symptoms and diagnoses must be reported, who you report them to, when an employee must be excluded or restricted from work, and how long they must stay away before returning. Master these rules and you will protect your customers, your coworkers, and your facility's permit.
Why Employee Health Reporting Matters
The U.S. Centers for Disease Control and Prevention has repeatedly found that ill food workers are one of the leading contributing factors in restaurant foodborne illness outbreaks, especially outbreaks caused by Norovirus. A single employee who comes to work with vomiting or diarrhea can contaminate ready-to-eat food, food-contact surfaces, and shared equipment in minutes. California law makes the food employee and the person in charge jointly responsible for catching this risk early. Reporting is not optional and not just a company policy: it is a legal duty under the California Health & Safety Code.
The Five Reportable Symptoms
A food employee must immediately tell the person in charge if they are experiencing any of five specific symptoms: vomiting, diarrhea, jaundice (yellowing of the skin or whites of the eyes), sore throat with fever, or an open or infected wound containing pus that is not properly covered. These symptoms are reportable whether they happened at work or at home, and whether they are mild or severe. The exam frequently asks you to identify the five symptoms and to recognize what is NOT on the list, such as a headache, a runny nose without fever, or a cough by itself.
The Big 6 Reportable Illnesses
In addition to symptoms, six specific diagnosed illnesses (often called the "Big 6") must be reported. They are: Norovirus, Hepatitis A, Shigella spp., Shiga-toxin producing E. coli (STEC, including O157:H7), Salmonella Typhi (which causes typhoid fever), and nontyphoidal Salmonella, which the FDA added to the list in 2017. Each of these is highly transmissible through food and can cause serious illness, especially in young children, the elderly, and immunocompromised people. An employee with any Big 6 diagnosis must be EXCLUDED from the facility and cannot return until cleared by the health authority.
Exclusion vs. Restriction
Two different responses exist when an employee is sick. EXCLUSION means the employee may not come to the food facility at all; not to work, not to be in the kitchen, not to be near food. RESTRICTION means the employee may be at work but may not work with food, food-contact surfaces (like cutting boards, knives, prep tables), or single-use items (like cups, straws, and to-go containers). Vomiting, diarrhea, jaundice, and any Big 6 diagnosis trigger exclusion. A sore throat with fever, in a facility that does not serve highly susceptible populations, typically triggers restriction. In a facility that does serve highly susceptible populations, sore throat with fever rises to full exclusion.
Handling Wounds, Cuts, and Boils
Open wounds, infected cuts, and pus-filled lesions are special: the bacteria most commonly involved (Staphylococcus aureus) can transfer onto food very easily. A wound on the hand or wrist must be covered with an impermeable (water-resistant) bandage AND covered again with a single-use glove or finger cot before the employee handles food. A wound on the arm needs the impermeable bandage plus a single-use sleeve or long glove. A cloth bandage, a paper towel, or a regular fabric Band-Aid alone is not enough because they are not waterproof and can leak through. If the wound cannot be properly covered, the employee should not work with food until it heals.
Reporting Exposure and Household Contacts
The reporting duty does not stop at the employee's own symptoms. California law also requires reporting of exposure: if the employee has had close contact with, or lives in the same household as, a person diagnosed with one of the Big 6, the employee must tell the person in charge. The same is true if the employee has attended an event or worked at a place where a confirmed outbreak occurred. The person in charge then contacts the local health department, which decides whether the employee can keep working, must be excluded, or needs testing or vaccination (especially for Hepatitis A). Hiding this information is a violation of the Retail Food Code.
Return-to-Work Rules
An employee excluded for vomiting or diarrhea (without a Big 6 diagnosis) may return to work only after being symptom-free for at least 24 hours WITHOUT the help of medication that masks the symptoms. "Feeling better," eating a meal, or waiting only a few hours is not enough. An employee with jaundice or any Big 6 diagnosis needs written medical clearance from the regulatory authority (typically the local health department) or a licensed physician, often after follow-up testing to confirm they are no longer contagious. A wound must remain properly covered with an impermeable bandage and glove until it is fully healed.
Duties of the Person in Charge (Manager)
The Person in Charge (PIC), usually the on-shift manager, has clear legal duties. When an employee reports a symptom or diagnosis, the PIC must: (1) decide whether to exclude or restrict the employee based on the symptom and the kind of facility, (2) keep that decision in effect until the return-to-work rule is met, and (3) notify the local health department whenever an employee is diagnosed with one of the Big 6. The PIC must also train employees so they understand the duty to report, and must make sure no sick employee is pressured to come to work. Allowing an obviously sick worker to handle food is a serious violation that can lead to closure of the facility.
Highly Susceptible Populations
Some customers are far more likely to be hospitalized or to die from a foodborne illness than the general public. The FDA Food Code calls these groups Highly Susceptible Populations (HSP) and lists three main categories: preschool-age children, older adults living in nursing homes or assisted-living facilities, and immunocompromised individuals such as cancer or HIV patients. Facilities that serve HSPs (schools, daycares, hospitals, nursing homes, senior centers) follow stricter rules. For example, sore throat with fever, which is only a RESTRICT condition in a normal restaurant, becomes a full EXCLUDE in an HSP facility. Knowing which population you serve changes how you respond to a sick employee.
Common Sources of Foodborne Illness
The CDC and FDA identify a short list of factors that cause most foodborne illness outbreaks, and food employees should be able to name them. They are: improper time or temperature control of food, poor personal hygiene (including not washing hands or working while sick), cross-contamination between raw and ready-to-eat food, contaminated equipment or food-contact surfaces, and food from an unsafe source. Notice that two of these five factors come directly back to the employee: hygiene and working while sick. That is why reporting and exclusion rules sit at the center of every food-handler course and exam.
Last updated: May 2026