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1. Which of the following is NOT one of the five symptoms a food employee must report to the person in charge?

California law and the FDA Food Code list five reportable symptoms: vomiting, diarrhea, jaundice, sore throat with fever, and an open or infected wound containing pus that is not properly covered. A mild headache by itself is not on that list.

2. A cook calls in and tells the manager she vomited twice last night. When may she safely return to handling food?

An employee excluded for vomiting or diarrhea may return only after being symptom-free for at least 24 hours without the help of medication that masks symptoms. Feeling better, eating a meal, or waiting only 12 hours is not enough under the Retail Food Code.

3. Which group of pathogens makes up the "Big 6" foodborne illnesses that a food employee must report?

The FDA Food Code and California law require employees to report diagnosis or exposure to six specific pathogens: Norovirus, Hepatitis A, Shigella spp., Shiga-toxin producing E. coli (STEC), Salmonella Typhi, and nontyphoidal Salmonella, which was added in 2017.

4. A server arrives at work with yellowing of the eyes and skin. What must the person in charge do?

Jaundice is a reportable symptom often linked to Hepatitis A. The Retail Food Code requires full EXCLUSION (not just restriction) from the facility and notification to the regulatory authority. The employee cannot return until cleared by the health department.

5. An employee has a small infected cut on her hand that is leaking pus. Which action complies with the California Retail Food Code?

A wound with pus must be covered with an impermeable (water-resistant) bandage AND a single-use glove or finger cot. A fabric bandage or paper towel is not impermeable and is not enough. Sanitizer is not designed for skin and does not cover the wound.

6. When a food employee is diagnosed with one of the Big 6 illnesses, who is the person in charge required to notify?

California law and the FDA Food Code require the Person in Charge to immediately notify the local health department (the regulatory authority) when an employee is diagnosed with Norovirus, Hepatitis A, Shigella, STEC, Salmonella Typhi, or nontyphoidal Salmonella. This protects the public and lets the health department investigate possible exposure.

7. A dishwasher reports a sore throat with a fever of 101°F. The facility does NOT serve a highly susceptible population. What is the correct action?

Sore throat WITH fever generally requires RESTRICTION (not full exclusion) in facilities that do not serve highly susceptible populations. The employee can still perform tasks that do not involve food or food-contact surfaces. In facilities serving the elderly, young children, or the immunocompromised, exclusion is required.

8. Which of the following is the food employee's own legal duty under California's reporting rule?

The employee's legal duty is to report immediately to the person in charge any of the five reportable symptoms, a diagnosed Big 6 illness, exposure to an outbreak, or living with someone who has a Big 6 illness. Waiting, self-diagnosing, or hiding the illness violates the Retail Food Code and puts customers at risk.

9. Which population is considered "highly susceptible" and triggers stricter exclusion rules?

The FDA Food Code defines a Highly Susceptible Population (HSP) as people who are more likely than the general public to be severely affected by foodborne illness: preschool-age children, older adults in nursing homes or assisted-living, and immunocompromised individuals (such as those with cancer or HIV). Facilities serving HSPs must EXCLUDE, not just restrict, employees with sore throat and fever.

10. A cook was excluded after being diagnosed with Salmonella. What does he need before he can return to work?

An employee diagnosed with any Big 6 illness may not return until the regulatory authority (local health department) and/or a licensed medical practitioner provides medical clearance, often after follow-up testing. The 24-hour symptom-free rule alone applies to vomiting/diarrhea WITHOUT a Big 6 diagnosis.

11. According to the CDC, which of the following is one of the most common contributing factors to foodborne illness outbreaks in restaurants?

CDC outbreak investigations repeatedly identify ill food workers, especially those with Norovirus, as a leading contributing factor in restaurant outbreaks. Other common factors include improper time and temperature control, cross-contamination, contaminated equipment, and food from an unsafe source.

12. A line cook tells the manager that his roommate was just diagnosed with Hepatitis A. What is the correct response?

California law requires employees to report not only their own diagnoses but also exposure: living with or having close contact with someone who has a Big 6 illness. The person in charge must report this to the health authority, which will decide whether the employee should be excluded, tested, or vaccinated.

13. According to the CDC, what is the single most common cause of foodborne illness outbreaks in the United States and the pathogen most often linked to sick food workers?

CDC surveillance data consistently identify Norovirus as the leading cause of foodborne illness in the U.S. It spreads very easily through the fecal-oral route, even from tiny amounts of vomit or stool, which is why an infected food worker who handles ready-to-eat food can sicken many customers. Norovirus symptoms (vomiting, watery diarrhea) usually start 12 to 48 hours after exposure.

14. A food handler diagnosed with Shiga-toxin producing E. coli (STEC), such as O157:H7, may transmit a severe complication if he returns to work too early. Which complication is most associated with STEC?

Shiga-toxin producing E. coli, including O157:H7, can cause severe bloody diarrhea that progresses in some patients (especially young children) to hemolytic uremic syndrome (HUS), which can lead to kidney failure. Because of this serious complication, STEC is one of the Big 6 illnesses, and an infected employee must be excluded until cleared by the health authority.

15. A line cook tells the PIC she has a sore throat with a fever of 101°F. The restaurant does NOT serve a highly susceptible population. Under the FDA Food Code, what is the correct action?

Under FDA Food Code §2-201, a sore throat with fever is a reportable symptom. In facilities that do NOT serve a highly susceptible population, the worker is RESTRICTED — she may stay in the building but cannot work with food, food-contact surfaces, or single-use items. Exclusion is only required when a highly susceptible population (HSP) is served.

16. Which of the following best describes a 'Highly Susceptible Population' (HSP) under the FDA Food Code?

A Highly Susceptible Population (HSP) is a group more likely to suffer serious illness from foodborne pathogens because of age or weakened immunity. Examples include nursing home residents, hospital patients, immunocompromised individuals, preschool-age children in custodial care, and pregnant women in such facilities. HSP settings trigger STRICTER rules — for example, sore throat with fever requires exclusion, not just restriction.

17. A dishwasher had vomiting and diarrhea overnight. He feels normal in the morning and has not taken any anti-nausea medication. Under the FDA Food Code, when may he return to food-handling duties?

FDA Food Code §2-201 requires that an employee with vomiting or diarrhea be EXCLUDED until they have been symptom-free for at least 24 hours without using symptom-suppressing medication. Medication can mask symptoms while the worker is still shedding pathogens, so a chemically suppressed worker is still considered ill.

18. A server reports yellowing of the skin and eyes (jaundice) that started two days ago. What is the correct exclusion period before she may return to food work?

Jaundice is a Big 6 reportable symptom strongly associated with Hepatitis A. The FDA Food Code requires that a food employee with jaundice be excluded until at least 7 days have passed since jaundice first appeared AND the regulatory authority or a medical practitioner approves return. If Hepatitis A is confirmed, additional medical clearance is required.

19. Why is Hepatitis A a particularly dangerous foodborne illness for restaurants to manage?

Hepatitis A virus has an incubation period of 15-50 days (average ~28). An infected food worker can shed the virus through stool for weeks before jaundice appears, contaminating ready-to-eat foods unnoticed. Because Hep A is vaccine-preventable, CDC recommends vaccination for food handlers, especially after a known exposure or outbreak.

20. A line cook cuts his finger while slicing onions. The wound is small but bleeding. Which step is the correct way to allow him to keep working?

An open cut on the hand must be cleaned, covered with an IMPERMEABLE (waterproof) bandage, and then enclosed by a single-use glove or finger cot. This double barrier prevents both blood and bacteria from contacting food. A wound on other parts of the body must be covered with an impermeable cover plus clothing. If the wound is infected or pus-filled, the employee must be excluded from food work.

21. Two customers at a deli call the health department within 24 hours saying they got sick with the same symptoms after eating there. The manager learns of this. What is the manager's correct first response?

When two or more people experience the same illness after eating food prepared or served at a facility, it meets the standard CDC/FDA definition of a suspected foodborne outbreak. The Person-in-Charge must immediately notify the local health department, preserve any suspect food and production records, and cooperate fully with the investigation. Concealing evidence is unlawful.

22. A line cook in California refuses to work because she has diarrhea and reports this to her manager. The manager threatens to fire her if she doesn't come in. Which legal protection applies?

California Labor Code §6310 and §6311 prohibit retaliation, including firing, against an employee who reports unsafe conditions to the employer or a government agency, or who refuses to perform hazardous work. Combined with FDA Food Code §2-201 (which makes illness reporting a duty), a food worker who reports symptoms or refuses to handle food while sick is legally protected from retaliation.

23. A baker attended a family wedding where several guests later tested positive for Norovirus. He himself has no symptoms. Under the FDA Food Code, what must he do?

FDA Food Code §2-201 requires food employees to report not only diagnoses and symptoms, but also EXPOSURE to outbreaks of Norovirus, Hepatitis A, Shigella, Shiga-toxin E. coli, Salmonella Typhi, and nontyphoidal Salmonella. Reporting an exposure even without symptoms allows the PIC and health department to monitor and prevent further spread, since some pathogens shed before symptoms appear.

24. Under HACCP principles, where does employee health and illness reporting fit?

Employee health and illness reporting is a PREREQUISITE program — a foundational sanitation/operational practice that must be in place for HACCP to work. CCPs control specific hazards (cooking temperatures, etc.), but if a sick employee contaminates ready-to-eat food, no CCP downstream will catch a virus like Norovirus. Strong health policy is the foundation of food safety.

25. What documentation does the FDA Food Code expect a Person-in-Charge to keep when an employee reports a reportable symptom or diagnosis?

FDA Food Code §2-201 expects the PIC to maintain a written or electronic Employee Health Policy/log documenting symptom and diagnosis reports, exposure reports, dates, and the action taken (restriction, exclusion, return-to-work approval). Health inspectors routinely ask to see these records. Employers should NOT keep private medical charts — only the information needed for food-safety compliance.

26. Which of the following is one of the CDC's top contributing factors to foodborne illness outbreaks in restaurants — and is directly addressed by illness-reporting policies?

CDC investigations consistently list poor personal hygiene by sick food workers among the top contributing factors to foodborne outbreaks, along with improper holding temperatures, contaminated equipment, food from unsafe sources, and inadequate cooking. Mandatory illness reporting and exclusion/restriction policies directly target this factor by keeping ill workers from contaminating food.

27. In addition to the FDA Big 6, which agency's regulations in California require reporting of further communicable diseases such as Listeria and Hepatitis E to public-health authorities?

California Code of Regulations (CCR) Title 17 lists communicable diseases that physicians, laboratories, and certain establishments must report to local health departments. Beyond the FDA Big 6, Title 17 includes additional agents such as Listeria monocytogenes and Hepatitis E. A PIC may not be the direct reporter for diagnosis, but should know that California adds reportable diseases beyond the federal Food Code list.

28. A prep cook is diagnosed with nontyphoidal Salmonella after eating undercooked eggs at home. Which food category is the leading source of this pathogen, and what is the correct return-to-work standard?

Nontyphoidal Salmonella (causing salmonellosis) is most commonly linked to raw or undercooked POULTRY and EGGS, and also raw produce and unpasteurized dairy. It is one of the FDA Big 6: an infected food employee must be EXCLUDED until medically cleared by the regulatory authority or a medical practitioner and free of vomiting/diarrhea for at least 24 hours. Diagnosis-based exclusions require formal clearance, not just self-assessment.

29. Under California's adoption of the FDA Food Code Big 6 reporting rule, which of the following pathogens is on the list that an employee must report to the person in charge if diagnosed?

California Health & Safety Code §113949 et seq. incorporates the FDA Food Code 2-201.11 'Big 6' reportable diagnoses for retail food workers: (1) Norovirus, (2) Hepatitis A virus (HAV), (3) Shigella species, (4) Salmonella Typhi (the cause of typhoid fever), (5) nontyphoidal Salmonella (added in the 2013 Food Code), and (6) Shiga toxin-producing E. coli (STEC, including O157:H7). These six are flagged because they are highly transmissible by the fecal-oral route, can be shed asymptomatically, and have caused major U.S. restaurant outbreaks. When a food employee is diagnosed with any of the six, the person in charge MUST notify the local health department and exclude the employee from work; written medical clearance is required before return. Option B lists respiratory pathogens, which are not on the Big 6 list (although they may trigger general sick-leave). Option C lists serious but non-reportable foodborne pathogens. Option D lists parasites, which can cause illness but are not in the Big 6 reporting trigger list.

30. A food employee reports jaundice (yellowing of skin and eyes) that started 5 days ago. What is the person in charge required to do?

California Retail Food Code HSC §113949.1 requires the person in charge to EXCLUDE — not merely restrict — any food employee with jaundice that has onset in the past 7 days, and to report the case to the local health department. Jaundice is the classic late symptom of Hepatitis A virus (HAV) infection; HAV is one of the Big 6 reportable pathogens, transmitted fecal-orally, and has caused multiple California restaurant outbreaks resulting in mass post-exposure vaccination campaigns. The 7-day onset window matters because HAV is most contagious in the 2 weeks BEFORE jaundice appears and remains contagious for about a week after, so a recently-jaundiced worker is still shedding virus. Option A endangers customers. Option B is non-compliant because exclusion (full removal from premises) is required, not just restriction to back-of-house. Option D underestimates HAV's infectious period — 24 hours of rest does nothing to eliminate viral shedding. Medical clearance is mandatory before return; HAV antibody testing or proof of recovery is the standard documentation.

31. A food employee called in this morning with vomiting and diarrhea. The symptoms began 36 hours ago and stopped 6 hours ago. When may they return to handling food, assuming no Big 6 pathogen has been diagnosed?

FDA Food Code 2-201.13(A)(1), adopted into California's Retail Food Code via HSC §113949.1, permits a food employee who was excluded for vomiting or diarrhea WITHOUT a Big 6 diagnosis to return to work when they have been ASYMPTOMATIC for at least 24 hours. Most California operators apply a 48-hour rule as a best practice because norovirus can be shed in stool for 48 hours after symptoms resolve and is the leading cause of unconfirmed acute gastroenteritis in foodservice — the 48-hour gap dramatically lowers the residual risk. The employee should not return earlier even if they feel well (option A), because pathogen shedding outlasts symptoms. Option C (4 hours) is far too short for any gastrointestinal recovery. Option D (one full week) is the requirement for confirmed Big 6 cases with a positive culture, NOT for unconfirmed gastroenteritis. If the employee IS later diagnosed with Norovirus, Shigella, STEC, Salmonella nontyphoidal, Salmonella Typhi, or Hepatitis A, written medical clearance is required regardless of how long they have been symptom-free.

32. A food employee tells the person in charge that they have a sore throat AND fever of 101°F. The facility serves a Highly Susceptible Population (HSP) — a senior assisted-living dining hall. What is the correct action?

FDA Food Code 2-201.11(B) and CRFC HSC §113949.1 require differential treatment of sore throat with fever based on the population served. In a standard restaurant, sore throat with fever is a RESTRICTION (the employee may be reassigned to non-food-contact work). In a Highly Susceptible Population (HSP) facility — defined as nursing homes, assisted-living, hospitals, daycare, preschool — the same symptom triggers full EXCLUSION because the residents are immunocompromised or otherwise at elevated risk from Group A Streptococcus, the bacterium most often associated with febrile pharyngitis. Option A is non-compliant in any setting because the symptom requires at minimum a restriction. Option B is the correct answer for a NON-HSP setting and is the trap distractor — students who do not catch the HSP keyword will choose it. Option C confuses exclusion with restriction; even with a negative strep test, the symptom-driven rule applies until the cause is determined. The employee may return when feverless without medical clearance, or with clearance if pathogen-confirmed.

33. A food employee was excluded after a positive stool culture for nontyphoidal Salmonella. What must occur before they are allowed to return to work?

California Retail Food Code HSC §113949.1, mirroring FDA Food Code 2-201.13(C), requires that any food employee excluded due to diagnosis with a Big 6 pathogen (Norovirus, Hepatitis A, Shigella, Salmonella Typhi, nontyphoidal Salmonella, or Shiga toxin-producing E. coli) may only return to work after WRITTEN medical clearance from a licensed healthcare provider OR from the local regulatory authority (county health department). The clearance must state that the employee is no longer infectious. For nontyphoidal Salmonella specifically, the typical reinstatement criteria are: asymptomatic for the time required by the regulatory authority OR documented negative stool specimens (the local health department determines exactly how many and how spaced). Option A omits the documentation requirement and applies only to UNDIAGNOSED gastroenteritis, not to Big 6 cases. Option B (verbal) does not satisfy the written-clearance rule. Option D is wrong because home-pharmacy tests are not approved diagnostic confirmation in California. The written-clearance rule protects against return-to-work errors and creates a defensible audit trail.

34. Under California Retail Food Code §113949.1, which of the following lists the BIG 6 foodborne pathogens that a food employee must report to the person in charge upon diagnosis, and that trigger immediate exclusion?

California Retail Food Code HSC §113949.1 (adopting FDA Food Code 2-201.11) names exactly six (sometimes called Big 5+1) reportable pathogens that an employee must disclose upon diagnosis: (1) NOROVIRUS — the leading cause of foodborne illness in the U.S.; (2) HEPATITIS A VIRUS — fecal-oral transmission, can survive on surfaces for weeks; (3) SHIGELLA spp. — extremely low infectious dose (10-100 organisms); (4) SHIGA TOXIN-PRODUCING E. COLI (STEC), including O157:H7 — life-threatening, can cause hemolytic uremic syndrome; (5) SALMONELLA TYPHI (typhoid fever) — chronic carrier risk; and (6) NONTYPHOIDAL SALMONELLA. Option A wrongly includes Hepatitis B (blood-borne, not foodborne) and Listeria (a regulatory concern but not on the employee report list) and mislabels E. coli (only the Shiga-toxin-producing strains are Big 6). Option B includes Hepatitis C (blood-borne) and is incomplete. Option D mixes in toxin-producers (Staph, Bacillus, Clostridium) that are not on the Big 6 reporting list because exclusion is based on the employee's diagnosis, not the toxin's presence in food. Upon a Big 6 diagnosis the PIC must exclude the employee AND notify the local enforcement agency.

35. Under California Retail Food Code §113949.4 and FDA Food Code 2-201.13, a food employee who had Norovirus symptoms (vomiting and/or diarrhea) must be EXCLUDED from the food facility for what minimum period after symptoms resolve, before being allowed to return to work?

California Retail Food Code HSC §113949.4 (and FDA Food Code 2-201.13) requires exclusion of a food employee who is experiencing symptoms of vomiting or diarrhea; the employee may return only when asymptomatic for at least 24 hours OR a longer period if required by the local health officer. For confirmed Norovirus or for unconfirmed but suspicious cases, the FDA Food Code recommends 24 hours symptom-free MINIMUM and many California local enforcement agencies and operators apply 48 hours as best practice because Norovirus is shed in stool for up to 2 weeks after recovery, the infectious dose is only 10-100 viral particles, and Norovirus is the leading cause of foodborne outbreaks in U.S. restaurants per CDC data. Option B leaves the decision to feelings, which is non-compliant and dangerously subjective. Option C is excessive and is not the standard. Option D applies a stool-culture standard that is appropriate for Typhoid Salmonella and Shigella but is not used for Norovirus (no widely available clinical Norovirus PCR test is required for return-to-work). For other Big 6 pathogens, return requires written medical clearance from the local health officer.

36. Under California Retail Food Code §113949.2, a food employee is diagnosed with HEPATITIS A virus. Which combination of actions is required by the person in charge?

California Retail Food Code HSC §113949.2 and §113949.4 require EXCLUSION (not just restriction) for a food employee diagnosed with Hepatitis A virus (HAV). 'Exclusion' under the code means the employee may not be in the food facility in any role — not dishwashing, not front counter, not cleaning. The reason is that HAV is shed in stool starting 1-2 weeks BEFORE symptoms appear and continuing 1-3 weeks after jaundice onset; the virus is exceptionally hardy (survives on surfaces and on hands for hours to days), the infectious dose is very low, and contamination can occur through any surface the employee touches. Action items: (1) immediate exclusion, (2) notify the local enforcement agency without delay (required for Big 6 pathogen diagnoses), (3) cooperate with the contact-tracing investigation, (4) post-exposure prophylaxis (HAV vaccine or immune globulin) within 14 days for exposed coworkers and possibly customers, (5) return only with written medical release. Options A, B, and C all keep an HAV-positive worker on premises and are non-compliant; multiple major U.S. outbreaks (e.g., 2003 Chi-Chi's outbreak, 660 sickened, 4 dead) trace to ignoring this rule.

37. Shiga toxin-producing E. coli (STEC), including E. coli O157:H7, is on California's Big 6 reportable list. Which food is the CLASSIC outbreak vehicle for STEC and what is the relevant cooking control?

California Retail Food Code HSC §113949.1 lists STEC (Shiga toxin-producing E. coli, including the well-known serotype O157:H7) as a Big 6 reportable pathogen. The classic outbreak vehicle is undercooked GROUND BEEF — the 1993 Jack-in-the-Box outbreak (4 children died, 700+ sickened) drove the federal switch to mandatory 155°F cooking for ground beef. Cattle are the primary reservoir, with the organism present in their intestines and shed in feces; ground beef pools surface-contaminated trim from many animals, distributing surface bacteria into the geometric center of every patty. Other documented vehicles: raw leafy greens contaminated by cattle-feces runoff (multiple romaine outbreaks 2017-2020), unpasteurized milk and juice, raw flour, mechanically tenderized whole-muscle beef, and venison. Cooking control under HSC §114004 is 155°F for 17 seconds (or equivalent time-temperature combination) in the center of the ground product. Option A is wrong; pasteurized dairy is the SAFE product. Option C describes poultry/Salmonella controls. Option D describes a temperature combination that does not apply to STEC. STEC's hemolytic uremic syndrome (HUS) is the leading cause of acute kidney failure in U.S. children.

38. Under California Retail Food Code §113949.2, JAUNDICE in a food employee (yellowing of the skin or whites of the eyes) requires what immediate action by the person in charge?

California Retail Food Code HSC §113949.2 lists jaundice (icterus, yellowing of skin or sclera) as one of the conditions requiring IMMEDIATE EXCLUSION of the employee from the food facility and IMMEDIATE notification of the local enforcement agency. Jaundice is treated as presumed Hepatitis A virus (HAV) infection until medically proven otherwise — the rule applies if the onset was within the past 7 days (older jaundice is handled differently per FDA Food Code 2-201.12). Exclusion means the employee may not be on premises in ANY capacity. Return requires written clearance from the local health officer (typically after laboratory confirmation rules out HAV or, if HAV is confirmed, after the infectious period has ended, usually 7 days after onset of jaundice). The reason for the immediate, strict response is that HAV infectiousness peaks BEFORE jaundice appears — by the time jaundice is visible, the employee has likely been shedding virus for 1-2 weeks and any food they touched in that period is suspect. Options A, B, and D all keep a presumed-HAV employee in the facility and are dangerously non-compliant; the 2003 Chi-Chi's outbreak (>660 cases) traced to ignoring exactly this protocol.

39. Under California Retail Food Code §113949.4, a food employee who EXPERIENCED A VOMITING EPISODE at work must be excluded for at least what minimum time after the last episode?

California Retail Food Code HSC §113949.4 (adopting FDA Food Code 2-201.13) requires exclusion of a food employee who vomits at work for a MINIMUM of 24 hours symptom-free after the last vomiting episode, before return. Vomiting is treated as a high-suspicion event for Norovirus, which can be aerosolized in vomit droplets and spread over a wide radius (documented dispersal up to 25 feet). The 24-hour minimum is consistent with the exclusion requirement for diarrhea; many California enforcement agencies and corporate operators apply 48 hours as a safer interval because Norovirus shedding continues well after symptoms stop. In addition to exclusion, California Retail Food Code §114049 (vomit and fecal accident cleanup) requires the facility to have a WRITTEN procedure for: (a) safely cleaning the contamination using an EPA-registered Norovirus-effective product (typically chlorine at ≥1000 ppm, or an EPA List G product), (b) discarding food in the splash radius, (c) isolating and re-sanitizing the area, and (d) evaluating exposed staff. Options A, B, and C are all shorter than the 24-hour code minimum and are non-compliant.