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, (P) II. On exposed portions of the arms, unless the lesion is protected by an impermeable cover, (P) or III. On other parts of the body, unless the lesion is covered by a dry, durable, tight-fitting bandage; (P)
(ii) Has an illness diagnosed by a health practitioner due to:
- (I) Norovirus, (P)
- (II) Hepatitis A virus, (P)
(III) Shigella spp., (P)
- (IV) Enterohemorrhagic or Shiga toxin-producing Escherichia coli, (P) or
- (V) Typhoid Fever or non-Typhi; (P)
- (iii) Had a previous illness, diagnosed by a health practitioner, within the past 3 months due to Typhoid Fever, without having received antibiotic therapy, as determined by a health practitioner; (P)
(iv) Has been exposed to, or is the suspected source of, a confirmed 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: (P)
- (I) Norovirus within the past 48 hours of the last exposure, (P)
- (II) Enterohemorrhagic or Shiga toxin-producing Escherichia coli, or Shigella spp. within the past 3 days of the last exposure, (P)
(III) Typhoid Fever within the past 14 days of the last exposure, (P) or
- (IV) Hepatitis A virus within the past 30 days of the last exposure; (P) or
(v) Has been exposed by attending or working in a setting where there is a confirmed 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 confirmed disease outbreak, or living in the same household as, and has knowledge about, an individual diagnosed with an illness caused by:
- (I) Norovirus within the past 48 hours of the last exposure, (P)
- (II) Enterohemorrhagic or Shiga toxin-producing Escherichia coli, (P) or Shigella spp. within the past 3 days of the last exposure,
(III) Typhoid Fever within the past 14 days of the last exposure, (P) or
- (IV) Hepatitis A virus within the past 30 days of the last exposure. (P)
- 2. The person in charge shall notify the department when a food employee is:
- (i) Jaundiced, (Pf) or
(ii) Diagnosed with an illness due to a pathogen as specified under items 1.(ii)(I)–(V) of this subparagraph. (Pf)
- 3. The person in charge shall ensure that a conditional employee:
- (i) Who exhibits or reports a symptom, or who reports a diagnosed illness as specified under subparts 1.(i)–1.(iii) of this subparagraph, is prohibited from becoming a food employee until the conditional employee meets the criteria for the specific symptoms or diagnosed illness as specified under 1200-23-01-.02(2)(c); (P) and
(ii) 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 subparts 1.(iv)–1.(v) of this subparagraph, is prohibited from becoming a food employee until the conditional employee meets the criteria as specified under 1200-23-01-.02(2)(c). (P)
- 4. 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 subparts 1.(i)–1.(v) of this subparagraph is:
- (i) Excluded as specified under 1200-23-01-.02(2)(b)1.–3., and subparts 4.(i), 5.(i), 6.(i), or 7.(i) and in compliance with the provisions specified under 1200-23-01-.02(2)(c)1.–7.; (P) or
(ii) Restricted as specified under 1200-23-01-.02(2)(b), and subparts 4.(ii), 5.(ii), 6.(ii), 7.(ii), or 1200-23-01-.02(2)(b)8. or 9. and in compliance with the provisions specified under 1200-23-01-.02(2)(c)4.–9. (P)
- 5. A food employee or conditional employee shall report to the person in charge the information as specified under part 1. of this subparagraph. (Pf)
- 6. A food employee shall:
- (i) Comply with an exclusion as specified under 1200-23-01-.02(2)(b)1.–3., subparts 4.(i), 5.(i), 6.(i), or 7.(i) and with the provisions specified under 1200-23-01-.02(2)(c)4.–9.; (P) or
- (ii) Comply with a restriction as specified under 1200-23-01-.02(2)(b)4.(ii), 5.(ii), 6.(ii), 7.(ii), or 1200-23-01-.02(2)(b)8. or 9. and comply with the provisions specified under 1200-23-01-.02(2)(c)4.–9. (P)
(b) Exclusions and Restrictions. The person in charge shall exclude or restrict a food employee from a food establishment in accordance with the following:
- 1. Except when the symptom is from a noninfectious condition, exclude a food employee if the food employee is:
- (i) Symptomatic with vomiting or diarrhea; (P) or
(ii) Symptomatic with vomiting or diarrhea and diagnosed with an infection from Norovirus, Shigella spp., or Enterohemorrhagic or Shiga toxin- producing E. coli. (P)
- 2. Exclude a food employee who is:
- (i) 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; (P)
- (ii) Diagnosed with an infection from hepatitis A virus within 14 calendar days from onset of any illness symptoms, or within 7 calendar days of the onset of jaundice; (P) or
(iii) Diagnosed with an infection from hepatitis A virus without developing symptoms. (P)
- 3. Exclude a food employee who is diagnosed with an infection from Typhoid Fever, or reports a previous infection with Typhoid Fever within the past 3 months as specified under subpart 1200-23-01-.02(2)(a)1.(iii).(P)
- 4. If a food employee is diagnosed with an infection from Norovirus and is asymptomatic:
- (i) Exclude the food employee who works in a food establishment serving a highly susceptible population; (P) or
(ii) Restrict the food employee who works in a food establishment not serving a highly susceptible population. (P)
- 5. If a food employee is diagnosed with an infection from Shigella spp. and is asymptomatic:
- (i) Exclude the food employee who works in a food establishment serving a highly susceptible population; (P) or
(ii) Restrict the food employee who works in a food establishment not serving a highly susceptible population. (P)
- 6. If a food employee is diagnosed with an infection from Enterohemorrhagic or Shiga toxin-producing E. coli, and is asymptomatic:
- (i) Exclude the food employee who works in a food establishment serving a highly susceptible population; (P) or
(ii) Restrict the food employee who works in a food establishment not serving a highly susceptible population. (P)
- 7. If a food employee is ill with symptoms of acute onset of sore throat with fever:
- (i) Exclude the food employee who works in a food establishment serving a highly susceptible population; (P) or
(ii) Restrict the food employee who works in a food establishment not serving a highly susceptible population. (P)
- 8. 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 1200-23-01-.02(2)(a)1.(i)(V), restrict the food employee. (P)
- 9. If a food employee is exposed to a foodborne pathogen as specified under 1200- 23-01-.02(2)(a)1.(iv) and (v), restrict the food employee who works in a food establishment serving a highly susceptible population. (P)
(c) Removal, Adjustment, or Retention of Exclusions and Restrictions. The person in charge shall adhere to the following conditions when removing, adjusting, or retaining the exclusion or restriction of a food employee:
- 1. Except when a food employee is diagnosed with an infection from hepatitis A virus or Typhoid Fever:
(i) Reinstate a food employee who was excluded as specified under 1200-23- 01-.02(2)(b)1.(i) if the food employee:
- (I) Is asymptomatic for at least 24 hours; (P) or
- (II) Provides to the person in charge written medical documentation from a health practitioner that states the symptom is from a noninfectious condition. (P)
(ii) If a food employee was diagnosed with an infection from Norovirus and excluded as specified under 1200-23-01-.02(2)(b)1.(ii):
- (I) 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 subparts 4.(i) or (ii) of this subparagraph are met; (P) or
- (II) 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 subparts 4.(i) or (ii) of this subparagraph are met.
- (P)
(iii) If a food employee was diagnosed with an infection from Shigella spp. and excluded as specified under 1200-23-01-.02(2)(b)1.(ii):
- (I) 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 subparts 5.(i) and (ii) of this subparagraph are met;
- (P) or
- (II) 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 subparts 5.(i) and (ii), or 5.(i) and (iii) of this subparagraph are met. (P)
(iv) If a food employee was diagnosed with an infection from Enterohemorrhagic or Shiga toxin-producing Escherichia coli and excluded as specified under 1200-23-01-.02(2)(b)1.(ii):
- (I) 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 subparts 6.(i) or (ii) of this subparagraph are met; (P) or
- (II) 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 subparts 6.(i) or (ii) are met. (P)
(v) If a food employee was diagnosed with an infection from nontyphoidal Salmonella and excluded as specified under 1200-23-01-.02(2)(b)1.(ii):
- (I) Restrict the food employee, who is asymptomatic, for at least 30 days until conditions for reinstatement as specified under subparts 6.(i) or (ii) of this subparagraph are met; (P) or
- (II) Retain the exclusion for the food employee who is symptomatic, until conditions for reinstatement as specified under subparts 6.(i) or (ii) of this subparagraph are met; (P)
- 2. Reinstate a food employee who was excluded as specified under 1200-23-01- .02(2)(b)2. if the person in charge obtains approval from the department and one of the following conditions is met;
- (i) The food employee has been jaundiced for more than 7 calendar days; (P)
- (ii) The anicteric food employee has been symptomatic with symptoms other than jaundice for more than 14 calendar days; (P) or
(iii) 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. (P)
- 3. Reinstate a food employee who was excluded as specified under 1200-23-01- .02(2)(b)3. if:
- (i) The person in charge obtains approval from the department; (P) and
(ii) 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. (P)
- 4. Reinstate a food employee who was excluded as specified under 1200-23-01- .02(2)(b)1.(ii) or 4.(i) who was restricted under 1200-23-01-.02(2)(b)4.(ii) if the person in charge obtains approval from the department and one of the following conditions is met:
- (i) 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; (P)
- (ii) 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; (P) or
(iii) 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. (P)
- 5. Reinstate a food employee who was excluded as specified under 1200-23-01- .02(2)(b)1.(ii) or 5.(i) or who was restricted under 1200-23-01-.02(2)(b)5.(ii) if the person in charge obtains approval from the department and one of the following conditions is met:
(i) 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:
- (I) Not earlier than 48 hours after discontinuance of antibiotics, (P) and
- (II) At least 24 hours apart; (P)
- (ii) 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; (P) or
(iii) 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. (P)
- 6. Reinstate a food employee who was excluded or restricted as specified under 1200-23-01-.02(2)(b)1.(ii) or 6.(i) or who was restricted under 1200-23-01- .02(2)(b)6.(ii) if the person in charge obtains approval from the department and one of the following conditions is met:
(i) 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:
- (I) Not earlier than 48 hours after discontinuance of antibiotics; (P) and
- (II) At least 24 hours apart; (P)
- (ii) 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; (P) or
(iii) The food employee was excluded or restricted and did not develop symptoms and more than 7 days have passed since the food employee was diagnosed. (P)
- 7. Reinstate a food employee who was excluded as specified under 1200-23-01- .02(2)(b) or who was restricted as specified under 1200-23-01-.02(2)(b) if the person in charge receives approval from the department and one of the following conditions is met
(i) 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 nontyphoidal Salmonella infection based on test results showing two consecutive negative stool specimen cultures that are taken:
- (I) Not earlier than 48 hours after the discontinuance of antibiotics (P); and
- (II) At least 24 hours apart; (P)
- (ii) 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; (P) or
(iii) The food employee was excluded or restricted and did not develop symptoms and more than 7 days have passed since the food employee was diagnosed. (P)
- 8. Reinstate a food employee who was excluded or restricted as specified under 1200-23-01-.02(2)(b)7.(i) or (ii) 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:
- (i) Has received antibiotic therapy for Streptococcus pyogenes infection for more than 24 hours; (P)
- (ii) Has at least one negative throat specimen culture for Streptococcus pyogenes infection; (P) or
(iii) Is otherwise determined by a health practitioner to be free of a Streptococcus pyogenes infection. (P)
- 9. Reinstate a food employee who was restricted as specified under 1200-23-01- .02(2)(b)8. if the skin, infected wound, cut, or pustular boil is properly covered with one of the following:
- (i) 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; (P)
- (ii) An impermeable cover on the arm if the infected wound or pustular boil is on the arm; (P) or
(iii) A dry, durable, tight-fitting bandage if the infected wound or pustular boil is on another part of the body. (P)
- 10. Reinstate a food employee who was restricted as specified under 1200-23-01- .02(2)(b)9. and was exposed to one of the following pathogens as specified under 1200-23-01-.02(2)(a)1.(iv) or (v):
(i) Norovirus and one of the following conditions is met:
- (I) More than 48 hours have passed since the last day the food employee was potentially exposed; (P) or
- (II) More than 48 hours have passed since the food employee’s household contact became asymptomatic. (P)
(ii) Shigella spp. or Enterohemorrhagic or Shiga toxin-producing Escherichia coli and one of the following conditions are met:
- (I) More than 3 calendar days have passed since the last day the food employee was potentially exposed; (P) or
- (II) More than 3 calendar days have passed since the food employee’s household contact became asymptomatic. (P)
(iii) Typhoid Fever and one of the following conditions are met:
- (I) More than 14 calendar days have passed since the last day the food employee was potentially exposed; (P) or
- (II) More than 14 calendar days have passed since the food employee’s household contact became asymptomatic. (P)
(iv) Hepatitis A virus and one of the following conditions is met:
- (I) The food employee is immune to hepatitis A virus infection because of a prior illness from hepatitis A; (P)
- (II) The food employee is immune to hepatitis A virus infection because of vaccination against hepatitis A; (P)
(III) The food employee is immune to hepatitis A virus infection because of IgG administration; (P)
- (IV) More than 30 calendar days have passed since the last day the food employee was potentially exposed; (P)
- (V) More than 30 calendar days have passed since the food employee’s household contact became jaundiced; (P) or
(VI) The food employee does not use an alternative procedure that allows bare hand contact with ready-to-eat food until at least 30 days after the potential exposure, as specified in items 9.(iv)(IV) and (V) of this subpart, and the food employee receives additional training about:
I. Hepatitis A symptoms and preventing the transmission of infection, (P) II. Proper handwashing procedures, (P) and III. Protecting ready-to-eat food from contamination introduced by bare hand contact. (P)
(3) Personal Cleanliness.
- (a) Clean Condition. Food employees shall keep their hands and exposed portions of their arms clean. (P)
(b) Cleaning Procedure.
- 1. Except as specified in 4. of this subparagraph, food employees shall clean their hands and exposed portions of their arms, including surrogate prosthetic devices for hands or arms for at least 20 seconds, using a cleaning compound in a handwashing sink that is equipped as specified under 1200-23-01-.05(2)(b)2. and/or 1200-23-01-.06(3)(a). (P)
- 2. Food employees shall use the following cleaning procedure in the order stated to clean their hands and exposed portions of their arms, including surrogate prosthetic devices for hands and arms:
- (i) Rinse under clean, running warm water; (P)
- (ii) Apply an amount of cleaning compound recommended by the cleaning compound manufacturer; (P)
(iii) Rub together vigorously for at least 10 to 15 seconds while:
- (I) Paying particular attention to removing soil from underneath the fingernails during the cleaning procedure, (P) and
- (II) Creating friction on the surfaces of the hands and arms or surrogate prosthetic devices for hands and arms, finger tips, and areas between the fingers; (P)
- (iv) Thoroughly rinse under clean, running warm water; (P) and
(v) Immediately follow the cleaning procedure with thorough drying using a method as specified under 1200-23-01-.06(3)(a)3. (P)
- 3. To avoid recontaminating their hands or surrogate prosthetic devices, food employees may use disposable paper towels or similar clean barriers when touching surfaces such as manually operated faucet handles on a handwashing sink or the handle of a restroom door.
- 4. If approved and capable of removing the types of soils encountered in the food operations involved, an automatic handwashing facility may be used by food employees to clean their hands or surrogate prosthetic devices.
(c) When to Wash. Food employees shall clean their hands and exposed portions of their arms as specified under 1200-23-01-.02(3)(b) immediately before engaging in food preparation including working with exposed food, clean equipment and utensils, and unwrapped single-service and single-use articles (P) and:
- 1. After touching bare human body parts other than clean hands and clean, exposed portions of arms; (P)
- 2. After using the toilet room; (P)
- 3. After caring for or handling service animals or aquatic animals as specified in 1200-23-01-.02(4)(d)2.; (P)
- 4. Except as specified in 1200-23-01-.02(4)(a)2., after coughing, sneezing, using a handkerchief or disposable tissue, using tobacco, eating, or drinking; (P)
- 5. After handling soiled equipment or utensils; (P)
- 6. During food preparation, as often as necessary to remove soil and contamination and to prevent cross contamination when changing tasks; (P)
- 7. When switching between working with raw food and working with ready-to-eat food; (P)
- 8. Before donning gloves for working with food; (P) and
- 9. After engaging in other activities that contaminate the hands. (P)
- (d) Where to Wash. Food employees shall clean their hands in a handwashing sink or approved automatic handwashing facility and may not clean their hands in a sink used for food preparation or warewashing, or in a service sink or a curbed cleaning facility used for the disposal of mop water and similar liquid waste. (Pf)
(e) Hand Antiseptics.
- 1. A hand antiseptic used as a topical application, a hand antiseptic solution used as a hand dip, or a hand antiseptic soap shall:
(i) Comply with one of the following:
- (I) Be an approved drug that is listed in the FDA publication Approved Drug Products with Therapeutic Equivalence Evaluations as an approved drug based on safety and effectiveness; (Pf) or
- (II) Have active antimicrobial ingredients that are listed in the FDA monograph for OTC Health-Care Antiseptic Drug Products as an antiseptic handwash, (Pf) and
(ii) Comply with one of the following:
- (I) Have components that are exempted from the requirement of being listed in federal food additive regulations as specified in 21 CFR § 170.39 - Threshold of regulation for substances used in food-contact articles; (Pf) or
(II) Comply with and be listed in:
I. 21 CFR Part 178 - Indirect Food Additives: Adjuvants, Production Aids, and Sanitizers as regulated for use as a food additive with conditions of safe use, (Pf) or II. 21 CFR Part 182 - Substances Generally Recognized as Safe, 21 CFR Part 184 - Direct Food Substances Affirmed as Generally Recognized as Safe, or 21 CFR Part 186 - Indirect Food Substances Affirmed as Generally Recognized as Safe for use in contact with food, (Pf) and III. Be applied only to hands that are cleaned as specified under 1200-23-01-.02(3)(b). (Pf)
- 2. If a hand antiseptic or a hand antiseptic solution used as a hand dip does not meet the criteria specified under (e)1.(ii) of this paragraph, use shall be:
- (i) Followed by thorough hand rinsing in clean water before hand contact with food or by the use of gloves; (Pf) or
(ii) Limited to situations that involve no direct contact with food by the bare hands.
- 3. A hand antiseptic solution used as a hand dip shall be maintained clean and at a strength equivalent to at least 100 mg/L chlorine. (Pf)
(f) Maintenance.
- 1. Food employees shall keep their fingernails trimmed, filed, and maintained so the edges and surfaces are cleanable and not rough. (Pf)
- 2. Unless wearing intact gloves in good repair, a food employee may not wear fingernail polish or artificial fingernails when working with exposed food. (Pf)
- (g) Prohibition. Except for a plain ring such as a wedding band, while preparing food, food employees may not wear jewelry including medical information jewelry on their arms and hands.
- (h) Clean Condition. Food employees shall wear clean outer clothing to prevent contamination of food, equipment, utensils, linens, and single-service and single-use articles.
(4) Hygienic Practices.
(a) Eating, Drinking, or Using Tobacco.
- 1. Except as specified in part 2. of this subparagraph, an employee shall eat, drink, or use any form of tobacco only in designated areas where the contamination of exposed food; clean equipment, utensils, and linens; unwrapped single-service and single-use articles; or other items needing protection cannot result.
- 2. A food employee may drink from a closed beverage container if the container is handled to prevent contamination of:
- (i) The employee’s hands;
- (ii) The container; and
- (iii) Exposed food; clean equipment, utensils, and linens; and unwrapped single-service and single-use articles.
- (b) Discharges from the Eyes, Nose, and Mouth. Food employees experiencing persistent sneezing, coughing, or a runny nose that causes discharges from the eyes, nose, or mouth may not work with exposed food; clean equipment, utensils, and linens; or unwrapped single-service or single-use articles.
(c) Effectiveness.
- 1. Except as provided in part 2. of this subparagraph, food employees shall wear hair restraints such as hats, hair coverings or nets, beard restraints, and clothing that covers body hair, that are designed and worn to effectively keep their hair from contacting exposed food; clean equipment, utensils, and linens; and unwrapped single-service and single-use articles.
- 2. This subparagraph does not apply to food employees such as counter staff who only serve beverages and wrapped or packaged foods, hostesses, and wait staff if they present a minimal risk of contaminating exposed food; clean equipment, utensils, and linens; and unwrapped single-service and single-use articles.
(d) Handling Prohibition.
- 1. Except as specified in part 2. of this subparagraph, food employees may not care for or handle animals that may be present such as patrol dogs, service animals, or pets that are allowed as specified in subparts 1200-23-01-.06(5)(o)2.(i)–(v). (Pf)
- 2. Food employees with service animals may handle or care for their service animals and food employees may handle or care for fish in aquariums or molluscan shellfish or crustacean in display tanks if they wash their hands as specified under 1200-23-01-.02(3)(b) and 1200-23-01-.02(3)(c)3.
(5) Responding to Contamination Events.
(a) Clean-up of vomiting and diarrheal events.
- 1. A food service establishment shall have written procedures for employees to follow when responding to vomiting or diarrheal events that involve the discharge of vomitus or fecal matter onto surfaces in the food service establishment. The procedures shall address the specific actions employees must take to minimize the spread of contamination and the exposure of employees, consumers, food, and surfaces to vomitus and fecal matter.