` Annex 7 Model Forms, Guides, and Other Aids. 1) Employee health information and Application form for bare hand contact Procedure

Transcription

1 ` Annex 7 Model Forms, Guides, and Other Aids 1) Employee health information and Application form for bare hand contact Procedure a) Form 1-A CONDITIONAL EMPLOYEE OR FOOD EMPLOYEE INTERVIEW b) Form 1-B CONDITIONAL EMPLOYEE OR FOOD EMPLOYEE REPORTING AGREEMENT c) Form 1-C CONDITIONAL EMPLOYEE OR FOOD EMPLOYEE MEDICAL REFERRAL d) Form 1-D APPLICATION FOR BARE HAND CONTACT PROCEDURE 2) Adoption information a) Form 2-A ADOPTION BY REFERENCE b) Form 2-B ADOPTION BY SECTION-BY-SECTION REFERENCE 3) Inspection information a) Form 3-A FOOD ESTABLISHMENT INSPECTION REPORT b) Guide 3-B INSTRUCTIONS FOR MARKING THE FOOD ESTABLISHMENT INSPECTION REPORT, INCLUDING FOOD CODE REFERENCES FOR RISK FACTORS/INTERVENTIONS AND GOOD RETAIL PRACTICES 4) Summary information a) Chart 4-A SUMMARY CHART FOR MINIMUM COOKING FOOD TEMPERATURES AND HOLDING TIMES REQUIRED BY CHAPTER 3 b) Chart 4-B SUMMARY CHART FOR MINIMUM FOOD TEMPERATURES AND HOLDING TIMES REQUIRED BY CHAPTER 3 FOR REHEATING FOODS FOR HOT HOLDING c) Chart 4-C SUMMARY CHART READY-TO-EAT, POTENTIALLY HAZARDOUS FOOD (TIME/TEMPERATURE, CONTROL FOR SAFETY FOOD) DATE MARKING (A) (E) AND DISPOSITION d) Chart 4-D FDA FOOD CODE MOBILE FOOD ESTABLISHMENT MATRIX e) Summary of Changes

2 The documents provided in this Annex are intended to facilitate adoption of the Food Code and the application of its provisions as they relate to conditional employees' and food employees' health and to food establishment inspections. Forms 1-A through 1-C are designed to assist those responsible for managing employees in order to prevent foodborne disease. The Food Code specifies that the permit holder is responsible for requiring conditional employees or food employees to report certain symptoms, diagnoses, and past illnesses, as they relate to diseases transmitted through food by infected workers. The conditional employee or food employee is personally responsible for reporting this information to the person in charge. Form 1-D is a user-aid for a regulatory agency when considering a request to allow bare hand contact with ready-to-eat food. Forms 2-A and 2-B can be used for the Code adoption process and Form 3-A is provided for use in recording HACCP information and inspectional observations. Guide 3-B Food Code References for Risk Factors/Interventions and Good Retail Practices Specified on the Food Establishment Inspection Report Form, has been merged with Guide 3-C Instructions for Marking the Food Establishment Inspection Report to become the new Guide 3-B, Instructions for Marking the Food Establishment Inspection Report, Including Food Code References for Risk Factors/Interventions and Good Retail Practices. The major headings from the Food Establishment Inspection Report form have been extracted and condensed in Guide 3-B to key word phrases to assist the person conducting inspections in locating the Food Code citation that corresponds to a given violation and recording inspectional observations. Guide 3-B is intended to be used during inspections to ensure that observations of the provisions of the Code are not overlooked during the inspection and accurately recorded on the Food Code Establishment Inspection Report form.

3 Conditional Employee and Food Employee Interview FORM 1-A Preventing Transmission of Diseases through Food by Infected Food Employees or Conditional Employees with Emphasis on Illness due to Norovirus, Salmonella Typhi (S. Typhi), Shigella spp., Enterohemorrhagic (EHEC) or ShigaToxin-producing Escherichia coli (STEC), or Hepatitis A Virus The purpose of this interview is to inform conditional employees and food employees to advise the person in charge of past and current conditions described so that the person in charge can take appropriate steps to preclude the transmission of foodborne illness. Conditional Employee Name (print) Food Employee Name (print) Address Telephone Daytime: Evening: Date Are you suffering from any of the following symptoms? (Circle one) If YES, Date of Onset Diarrhea? YES / NO Vomiting? YES / NO Jaundice? YES / NO Sore throat with fever? YES / NO Or Infected cut or wound that is open and draining, or lesions containing pus on the hand, wrist, an exposed body part, or other body part and the cut, wound, or lesion not properly covered? (Examples: boils and infected wounds, however small) YES / NO In the Past: Have you ever been diagnosed as being ill with typhoid fever (S.Typhi) If you have, what was the date of the diagnosis? If within the past 3 months, did you take antibiotics for S. Typhi? If so, how many days did you take the antibiotics? If you took antibiotics, did you finish the prescription? YES / NO YES / NO YES / NO History of Exposure: 1. Have you been suspected of causing, or have you been exposed to, a confirmed foodborne disease outbreak recently? YES / NO If YES, date of outbreak: a. If YES, what was the cause of the illness and did it meet the following criteria? Cause: i. Norovirus (last exposure within the past 48 hours) Date of illness outbreak ii. E. coli O157:H7 infection (last exposure within the past 3 days) Date of illness outbreak iii. Hepatitis A virus (last exposure within the past 30 days) Date of illness outbreak iv. Typhoid fever (last exposure within the past 14 days) Date of illness outbreak v. Shigellosis (last exposure within the past 3 days) Date of illness outbreak

4 b. If YES, did you: i. Consume food implicated in the outbreak? ii. Work in a food establishment that was the source of the outbreak? iii. Consume food at an event that was prepared by person who is ill? 2. Did you attend an event or work in a setting, recently where there was a confirmed disease outbreak? YES / NO If so, what was the cause of the confirmed disease outbreak? If the cause was one of the following five pathogens, did exposure to the pathogen meet the following criteria? a. Norovirus (last exposure within the past 48 hours) YES / NO b. E. coli O157:H7 (or other EHEC/STEC (last exposure within the past 3 days) YES / NO c. Shigella spp. (last exposure within the past 3 days) YES / NO d. S. Typhi (last exposure within the past 14 days) YES / NO e. Hepatitis A virus (last exposure within the past 30 days) YES / NO Do you live in the same household as a person diagnosed with Norovirus, shigellosis, typhoid fever, hepatitis A, or illness due to E. coli O157:H7 or other EHEC/STEC? YES / NO Date of onset of illness 3. Do you have a household member attending or working in a setting where there is a confirmed disease outbreak of Norovirus, typhoid fever, shigellosis, EHEC/STEC infection, or hepatitis A? YES / NO Date of onset of illness Name, Address, and Telephone Number of your Health Practitioner or doctor: Name Address Telephone Daytime: Evening: Signature of Conditional Employee Date Signature of Food Employee Date Signature of Permit Holder or Representative Date

5 Conditional Employee or Food Employee Reporting Agreement FORM 1-B Preventing Transmission of Diseases through Food by Infected Conditional Employees or Food Employees with Emphasis on Illness due to Norovirus, Salmonella Typhi, Shigella spp., Enterohemorrhagic (EHEC) or Shiga toxin-producing Escherichia coli (STEC), or Hepatitis A Virus The purpose of this agreement is to inform conditional employees or food employees of their responsibility to notify the person in charge when they experience any of the conditions listed so that the person in charge can take appropriate steps to preclude the transmission of foodborne illness. I AGREE TO REPORT TO THE PERSON IN CHARGE: Any Onset of the Following Symptoms, Either While at Work or Outside of Work, Including the Date of Onset: 1. Diarrhea 2. Vomiting 3. Jaundice 4. Sore throat with fever 5. Infected cuts or wounds, or lesions containing pus on the hand, wrist, an exposed body part, or other body part and the cuts, wounds, or lesions are not properly covered (such as boils and infected wounds, however small) Future Medical Diagnosis: Whenever diagnosed as being ill with Norovirus, typhoid fever (Salmonella Typhi), shigellosis (Shigella spp. infection), Escherichia coli O157:H7 or other EHEC/STEC infection, or hepatitis A (hepatitis A virus infection) Future Exposure to Foodborne Pathogens: 1. Exposure to or suspicion of causing any confirmed disease outbreak of Norovirus, typhoid fever, shigellosis, E. coli O157:H7 or other EHEC/STEC infection, or hepatitis A. 2. A household member diagnosed with Norovirus, typhoid fever, shigellosis, illness due to EHEC/STEC, or hepatitis A. 3. A household member attending or working in a setting experiencing a confirmed disease outbreak of Norovirus, typhoid fever, shigellosis, E. coli O157:H7 or other EHEC/STEC infection, or hepatitis A. I have read (or had explained to me) and understand the requirements concerning my responsibilities under the Food Code and this agreement to comply with: 1. Reporting requirements specified above involving symptoms, diagnoses, and exposure specified; 2. Work restrictions or exclusions that are imposed upon me; and 3. Good hygienic practices. I understand that failure to comply with the terms of this agreement could lead to action by the food establishment or the food regulatory authority that may jeopardize my employment and may involve legal action against me. Conditional Employee Name (please print) Signature of Conditional Employee Date Food Employee Name (please print) Signature of Food Employee Date Signature of Permit Holder or Representative Date

6 FORM 1-C Conditional Employee or Food Employee Medical Referral Preventing Transmission of Diseases through Food by Infected Food Employees with Emphasis on Illness due to Norovirus, Typhoid fever (Salmonella Typhi), Shigellosis (Shigella spp.), Escherichia coli O157:H7 or other Enterohemorrhagic (EHEC) or Shiga Toxin-producing Escherichia coli (STEC), and Hepatitis A Virus The Food Code specifies, under Part 2-2 Employee Health Subpart Disease or Medical Condition, that Conditional Employees and Food Employees obtain medical clearance from a health practitioner licensed to practice medicine, unless the Food Employees have complied with the provisions specified as an alternative to providing medical documentation, whenever the individual: 1. Is chronically suffering from a symptom such as diarrhea; or 2. Has a current illness involving Norovirus, typhoid fever (Salmonella Typhi), shigellosis (Shigella spp.) E. coli O157:H7 infection (or other EHEC/STEC), or hepatitis A virus (hepatitis A), or 3. Reports past illness involving typhoid fever (S. Typhi) within the past three months (while salmonellosis is fairly common in U.S., typhoid fever, caused by infection with S. Typhi, is rare). Conditional Employee being referred: (Name, please print) Food Employee being referred: (Name, please print) 4. Is the employee assigned to a food establishment that serves a population that meets the Food Code definition of a highly susceptible population such as a day care center with preschool-age children, a hospital kitchen with immunocompromised persons, or an assisted living facility or nursing home with older adults? YES NO Reason for Medical Referral: The reason for this referral is checked below: Is chronically suffering from vomiting or diarrhea; or (specify) Diagnosed or suspected Norovirus, typhoid fever, shigellosis, E. coli O157:H7 (or other EHEC/STEC) infection, or hepatitis A. (Specify) Reported past illness from typhoid fever within the past 3 months. (Date of illness) Other medical condition of concern per the following description: Health Practitioner s Conclusion: (Circle the appropriate one; refer to reverse side of form) Food employee is free of Norovirus infection, typhoid fever (S. Typhi infection), Shigella spp. infection, E. coli O157:H7 (or other EHEC/STEC infection), or hepatitis A virus infection, and may work as a food employee without restrictions. Food employee is an asymptomatic shedder of E. coli O157:H7 (or other EHEC/STEC), Shigella spp., or Norovirus, and is restricted from working with exposed food; clean equipment, utensils, and linens; and unwrapped single-service and single-use articles in food establishments that do not serve highly susceptible populations. Food employee is not ill but continues as an asymptomatic shedder of E. coli O157:H7 (or other EHEC/STEC), Shigella spp. and should be excluded from food establishments that serve highly susceptible populations such as those who are preschool-age, immunocompromised, or older adults and in a facility that provides preschool custodial care, health care, or assisted living. Food employee is an asymptomatic shedder of hepatitis A virus and should be excluded from working in a food establishment until medically cleared. Food employee is an asymptomatic shedder of Norovirus and should be excluded from working in a food establishment until medically cleared, or for at least 24 hours from the date of the diagnosis. Food employee is suffering from Norovirus, typhoid fever, shigellosis, E. coli O157:H7 (or other EHEC/STEC infection), or hepatitis A and should be excluded from working in a food establishment.

7 COMMENTS: (In accordance with Title I of the Americans with Disabilities Act (ADA) and to provide only the information necessary to assist the food establishment operator in preventing foodborne disease transmission, please confine comments to explaining your conclusion and estimating when the employee may be reinstated.) Signature of Health Practitioner Date

8 Paraphrased from the FDA Food Code for Health Practitioner s Reference From Subparagraph (A)(2) Organisms of Concern: Any foodborne pathogen, with special emphasis on these 5 organisms: 1. Norovirus 2. S. Typhi 3. Shigella spp. 4. E. coli O157:H7 (or other EHEC/STEC) 5. Hepatitis A virus From Subparagraph (A)(1) Symptoms: Have any of the following symptoms: Diarrhea Vomiting Jaundice Sore throat with fever From Subparagraph (A)(4)-(5) Conditions of Exposure of Concern: (1) Suspected of causing a foodborne outbreak or being exposed to an outbreak caused by 1 of the 5 organisms above, at an event such as a family meal, church supper, or festival because the person: Prepared or consumed an implicated food; or Consumed food prepared by a person who is infected or ill with the organism that caused the outbreak or who is suspected of being a carrier; (2) Lives with, and has knowledge about, a person who is diagnosed with illness caused by 1 of the 5 organisms; or (3) Lives with, and has knowledge about, a person who works where there is an outbreak caused by 1 of the 5 organisms. From Subparagraph Exclusion and Restriction: Decisions to exclude or restrict a food employee are made considering the available evidence about the person=s role in actual or potential foodborne illness transmission. Evidence includes: Symptoms Diagnosis Past illnesses Stool/blood tests In facilities serving highly susceptible populations such as day care centers and health care facilities, a person for whom there is evidence of foodborne illness is almost always excluded from the food establishment. In other establishments such as restaurants and retail food stored, that offer food to typically healthy consumers, a person might only be restricted from certain duties, based on the evidence of foodborne illness. Exclusion from any food establishment is required when the person is: Exhibiting or reporting diarrhea or vomiting; Diagnosed with illness caused by S. Typhi; or Jaundiced within the last 7 days. For Shigella spp. or Escherichia coli O157:H7 or other EHEC/STEC infections, the person s stools must be negative for 2 consecutive cultures taken no earlier than 48 hours after antibiotics are discontinued, and at least 24 hours apart or the infected individual must have resolution of symptoms for more than 7 days or at least 7 days have passed since the employee was diagnosed.

9 FORM 1-D Application for Bare Hand Contact Procedure (As specified in Food Code (D)) Please type or print legibly using black or blue ink 1. Establishment Name: 2. Establishment Address: 3. Responsible Person: Phone: Legal Representative Business 4. List Procedure and Specific Ready-To-Eat-Foods to be considered for use of bare hand contact with ready-to-eat foods: 5. Handwashing Facilities: (a) There is a handwashing sink located immediately adjacent to the posted bare hand contact procedure and the hand sink is maintained in accordance with provisions of the Code. ( , , , ) YES NO (Include diagram, photo or other information) (b) All toilet rooms have one or more handwashing sinks in, or immediately adjacent to them, and the sinks are equipped and maintained in accordance with provisions of the Code. ( , , , ) YES NO 6. Employee Health Policy: The written employee health policy must be attached to this form along with documentation that food employees and conditional employees acknowledge their responsibilities. ( , , ) 7. Employee Training: Provide documentation that food employees have received training in: The risks of contacting the specific ready-to-eat foods with bare hands Personal health and activities as they relate to diseases that are transmissible through food. Proper handwashing procedures to include how, when, where to wash, & fingernail maintenance. ( , , , ) Prohibition of jewelry. ( ) Good hygienic practices. ( , ) 8. Documentation of Handwashing Practices: Provide documentation that food employees are following proper handwashing procedures prior to food preparation and other procedures as necessary to prevent cross-contamination during all hours of operation when the specific ready-to-eat foods are prepared or touched with bare hands. 9. Documentation of Additional Control Measures: Provide documentation to demonstrate that food employees are utilizing two or more of the following control measures when contacting ready-to-eat foods with bare hands: Double handwashing; Use of nailbrushes; Use of hand antiseptic after handwashing; Incentive programs such as paid leave encouraging food employees not to work when they are ill; or Other control measures approved by the regulatory authority. Statement of Compliance: I certify all of the following: All food employees are individually trained in the risks of contacting ready-to-eat foods with bare hands, personal health and activities as they relate to diseases that are transmissible through food, proper handwashing procedures, prohibition of jewelry, and good hygienic practices. A record of this training is kept on site. I understand that bare hand contact with ready-to-eat food is prohibited except for those items listed in section four (4) above. A handwashing sink is located immediately adjacent to the posted bare hand contact procedure. All handwashing sinks are maintained with hot water, soap, and drying devices. I understand that documentation is needed for handwashing practices and additional control measures. I understand that records to document handwashing are kept current and kept on site. SIGNATURE: DATE (Signature of legal representative of the facility listed above) Regulatory Authority (RA) Use Only: Permit Number: File Review Conducted on History of Handwashing Compliance: Yes No Site Visit Conducted Yes No Comments: Approved: Effective Date: RA name Not Approved: Reason for Denial:

10 FORM 2-A Adoption by Reference This "short form" may be used by governmental bodies adopting the Food Code where authorized by law. Use of the adoption by reference form may substantially reduce the cost of publishing and printing. The description of the Food Code, below, includes Chapter 8 and the Chapter 8 annex (Annex 1). Modifications to the description may be necessary, based on what provisions are being adopted and whether they are being adopted as law or regulation. Section 2 lists provisions that may require modifications to be consistent with existing law or that require insertion of dollar amounts. (JURISDICTION) FOOD CODE (statute/regulation/ordinance) Number ADOPTING THE 2009 EDITION OF THE "FOOD CODE" REGULATING THE RETAIL SALE, COMMERCIAL AND INSTITUTIONAL SERVICE, AND VENDING OF FOOD; DEFINING PERMIT HOLDER, PERSON IN CHARGE, EMPLOYEE, FOOD, POTENTIALLY HAZARDOUS FOOD (TIME/TEMPERATURE CONTROL FOR SAFETY FOOD), FOOD ESTABLISHMENT, SAFE MATERIAL, SANITIZATION, AND OTHER TERMS; AND PROVIDING STANDARDS FOR EMPLOYEE FOOD SAFETY KNOWLEDGE, HEALTH, AND PRACTICES; FOOD SOURCES, PREPARATION, HOLDING TEMPERATURES, AND PROTECTION; EQUIPMENT DESIGN, CONSTRUCTION, INSTALLATION, CLEANING, AND SANITIZATION; WATER, AND LIQUID AND SOLID WASTES; FACILITIES CONSTRUCTION AND MAINTENANCE, AND STORAGE AND USE OF POISONOUS AND TOXIC MATERIALS; REQUIRING A PERMIT TO OPERATE A FOOD ESTABLISHMENT; AND PROVIDING FOR THE RESTRICTION OR EXCLUSION OF EMPLOYEES, THE EXAMINATION AND CONDEMNATION OF FOOD, AND THE ENFORCEMENT OF THIS CODE INCLUDING THE SETTING OF PENALTIES. The (governing body) of the (jurisdiction) does ordain as follows: SECTION 1. ADOPTION OF FOOD CODE That a certain document, three copies of which are on file in the office of the (jurisdiction's keeper of records) of the (type of jurisdiction) of (name of jurisdiction) being marked and designated as the Food Code, 2009 Recommendations of the United States Public Health Service/Food and Drug Administration as published by the U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration be, and is hereby adopted as, the Food Code of (type of jurisdiction) of (name of jurisdiction) in the State of (state name); for regulating the design, construction, management, and operation of food establishments, and providing for plans submission and approval and the issuance of permits and collection of fees therefore. SECTION 2. INSERTIONS AND CHANGES That the following provisions are hereby revised as follows: Paragraph (B)(1) and (2) Insert (Dollar Amount) Paragraph (B) Insert (Dollar Amounts) Subparagraph (B)(2) Insert (Number of Year(s))

11 SECTION 3. INCONSISTENT CODES REPEALED That (statute/regulation/ordinance) number (present code number) of the (jurisdiction) titled, (complete title of the food code[s] in effect at the present time so they will be repealed by definite mention) and all other codes or portions of codes in conflict herewith are hereby repealed in that respect only. SECTION 4. CERTIFICATION OF ADOPTION AND PUBLISHING That the (jurisdiction's keeper of records) shall certify the adoption of this (statute/regulation/ordinance and cause the same to be published as required by law. SECTION 5. EFFECTIVE DATE That this Code and the rules, regulations, provisions, requirements, orders, and matters established and adopted hereby shall take effect and be in full force and effect (time period) from and after the date of its final passage and approval. PASSED AND APPROVED BY (name of adopting authority) on this (day) of (month, year). BY: Examples of how some jurisdictions have set fines, sentences, and penalties: California law provides: A. For Wholesale Food Violations: Criminal fines and sentence for violations of up to $1,000 and up to one year imprisonment if there is shown an intent to defraud or mislead, and Civil penalties of up to $1,000 per day for certain violations. B. For Retail Food Violations: Criminal fines and sentence for violations of not less than twenty-five dollars ($25) or more than one thousand dollars ($1000) for each offense, or by imprisonment in the county jail for a term not exceeding six months, or by both such fine and imprisonment. Maryland law provides: Criminal fines and sentence for certain misdemeanors of up to $10,000 and one year imprisonment, and in the case of repeat code violation convictions, up to $25,000 and three years imprisonment; and Civil penalties of up to $5,000 for each violation and for each day the violation continues. Texas law provides: Criminal fines and sentence for certain violations of up to $10,000 and two years imprisonment; and Assessment of five "severity" levels of administrative or civil penalties with base amounts ranging from $1,250 through $10,000. Base amounts can be decreased or increased by as much as 50% considering factors such as past performance, good faith, direct impact on health and safety, high-risk populations involved, etc. Though rarely used with retail food establishments, Federal law provides under the Criminal Fine Enforcement Act of 1984 for a fine up to $100,000 for a misdemeanor by a corporation or individual not resulting in death and, for misdemeanors resulting in death, a fine of up to $250,000 for individuals and $500,000 for corporations.

12 FORM 2-B Adoption by Section-by-Section Reference This "long form" may be used by governmental bodies adopting the Food Code section-by-section. The description of the "Food Code," below, includes Chapter 8 and the Chapter 8 annex (Annex 1). Modifications to the description may be necessary, based on what provisions are being adopted and whether they are being adopted as law or regulation. Section 2 lists provisions that may require modifications to be consistent with existing law or that require insertion of dollar amounts. (JURISDICTION) FOOD CODE (statute/regulation/ordinance) Number ADOPTING A CODE REGULATING THE RETAIL SALE, COMMERCIAL AND INSTITUTIONAL SERVICE, AND VENDING OF FOOD; DEFINING PERMIT HOLDER, PERSON IN CHARGE, EMPLOYEE, FOOD, POTENTIALLY HAZARDOUS FOOD (TIME/TEMPERATURE CONTROL FOR SAFETY FOOD), FOOD ESTABLISHMENT, SAFE MATERIAL, SANITIZATION, AND OTHER TERMS; AND PROVIDING STANDARDS FOR EMPLOYEE FOOD SAFETY KNOWLEDGE, HEALTH, AND PRACTICES; FOOD SOURCES, PREPARATION, HOLDING TEMPERATURES, AND PROTECTION; EQUIPMENT DESIGN, CONSTRUCTION, INSTALLATION, CLEANING AND SANITIZATION; WATER, AND LIQUID AND SOLID WASTES; FACILITIES CONSTRUCTION AND MAINTENANCE, AND STORAGE AND USE OF POISONOUS AND TOXIC MATERIALS; REQUIRING A PERMIT TO OPERATE A FOOD ESTABLISHMENT; AND PROVIDING FOR THE RESTRICTION OR EXCLUSION OF EMPLOYEES, THE EXAMINATION AND CONDEMNATION OF FOOD, AND THE ENFORCEMENT OF THIS CODE INCLUDING THE SETTING OF PENALTIES. The (governing body) of the (jurisdiction) does ordain as follows: (REPRINT THE FOOD CODE, (date) RECOMMENDATIONS OF THE UNITED STATES PUBLIC HEALTH SERVICE/FOOD AND DRUG ADMINISTRATION, SECTION-BY-SECTION) SECTION 2. INSERTIONS AND CHANGES That the following provisions may need to be completed as follows: Paragraph (B)(1) and (2) Insert (Dollar Amount) Paragraph (B) Insert (Dollar Amounts) Subparagraph (B)(2) Insert (Number of Year(s)) SECTION 3. INCONSISTENT CODES REPEALED That (statute/regulation/ordinance) number (present code number) of the (jurisdiction) titled, (complete title of the food code[s] in effect at the present time so they will be repealed by definite mention) and all other codes or portions of codes in conflict herewith are hereby repealed in that respect only.

13 SECTION 4. CERTIFICATION OF ADOPTION AND PUBLISHING That the (jurisdiction's keeper of records) shall certify the adoption of this (statute/regulation/ordinance) and cause the same to be published as required by law. SECTION 5. EFFECTIVE DATE That this Code and the rules, regulations, provisions, requirements, orders, and matters established and adopted hereby shall take effect and be in full force and effect (time period) from and after the date of its final passage and approval. PASSED AND APPROVED BY (name of adopting authority) on this (day) of (month, year). BY: Examples of how some jurisdictions have set fines, sentences, and penalties: California law provides: A. For Wholesale Food Violations: Criminal fines and sentence for violations of up to $1,000 and up to one year imprisonment if there is shown an intent to defraud or mislead, and Civil penalties of up to $1,000 per day for certain violations. B. For Retail Food Violations: Criminal fines and sentence for violations of not less than twenty-five dollars ($25) or more than one thousand dollars ($1000) for each offense, or by imprisonment in the county jail for a term not exceeding six months, or by both such fine and imprisonment. Maryland law provides: Criminal fines and sentence for certain misdemeanors of up to $10,000 and one year imprisonment, and in the case of repeat code violation convictions, up to $25,000 and three years imprisonment; and Civil penalties of up to $5,000 for each violation and for each day the violation continues. Texas law provides: Criminal fines and sentence for certain violations of up to $10,000 and two years imprisonment; and Assessment of five "severity" levels of administrative or civil penalties with base amounts ranging from $1,250 through $10,000. Base amounts can be decreased or increased by as much as 50% considering factors such as past performance, good faith, direct impact on health and safety, high-risk populations involved, etc. Though rarely used with retail food establishments, Federal law provides under the Criminal Fine Enforcement Act of 1984 for a fine up to $100,000 for a misdemeanor by a corporation or individual not resulting in death and, for misdemeanors resulting in death, a fine of up to $250,000 for individuals and $500,000 for corporations.

14 FORM 3-A Food Establishment Inspection Report The food establishment inspection report is the official regulatory authority document regarding compliance of the establishment with agency requirements. The goal of the report is to clearly, concisely, and fairly present the compliance status of the establishment and to convey compliance information to the permit holder or person in charge at the conclusion of the inspection. The Food Establishment Inspection Report form is provided as a model for use during routine, follow-up, and investigative inspections. Refer to Annex 5 for further information.

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16 Guide 3-B Instructions for Marking the Food Establishment Inspection Report, Including Food Code References for Risk Factors/Interventions and Good Retail Practices Guide 3-B Food Code References for Risk Factors/Interventions and Good Retail Practices Specified on the Food Establishment Inspection Report Form, has been merged with Guide 3-C Instructions for Marking the Food Establishment Inspection Report to become the new Guide 3-B, Instructions for Marking the Food Establishment Inspection Report, Including Food Code References for Risk Factors/Interventions and Good Retail Practices. The major headings from the Food Establishment Inspection Report form have been extracted and condensed in Guide 3-B to key word phrases to assist the person conducting inspections in locating the Food Code citation that corresponds to a given violation and recording inspectional observations. Guide 3-B is intended to be used during inspections to ensure that observations of the provisions of the Code are not overlooked during the inspection and accurately recorded on the Food Code Establishment Inspection Report form.

17 GUIDE 3-B Instructions for Marking the Food Establishment Inspection Report page 2 GUIDE 3-B Instructions for Marking the Food Establishment Inspection Report, Including Food Code References for Risk Factors/Interventions and Good Retail Practices All references and code sections in these marking instructions are based on the 2009 Food Code. A. GENERAL MARKING INSTRUCTIONS HEADER Information Establishment Address Zip Code Telephone License/Permit # Permit Holder Purpose Est. Type Risk Category Number of Risk Factor/ Intervention Violations Number of Repeat Risk Factor/Intervention Violations Score (optional) Date Time In Time Out Complete this section using the usual/common name or Doing Business As name of the business. This information should be the same as the license/permit application completed at the initiation of the business. Street address of the actual business location Actual business location Contact phone number for the establishment License number or tracking identification Name of Owner or Operator as shown on application The reason for the inspection routine, reinspection, complaint, or follow-up, etc. Description or code for describing the type of facility (e.g. restaurant, market, vehicle, temporary food facility) Designation of risk/priority level for determining frequency of inspection The number of boxes marked OUT in items 1-27 should be counted and the total number placed here The number of boxes marked R (repeat) in items 1-27 should be counted and the total number placed here A score is optional for this form. If a jurisdiction has a scoring system, it should be incorporated into the inspection form and the score of an inspection placed here. The date of the inspection including month, day, and year The actual time the inspection begins The actual time the inspection ends B. RISK FACTORS AND INTERVENTIONS Risk factors are food preparation practices and employee behaviors most commonly reported to the Centers for Disease Control and Prevention (CDC) as contributing factors in foodborne illness outbreaks. Risk factors include: Food from Unsafe Sources, Improper Holding Temperatures, Inadequate Cooking, Contaminated Equipment, and Poor Personal Hygiene. These items are prominent on the Food Establishment Inspection Report because maintaining these items in compliance is vital to preventing foodborne illness. Additionally, five key public health interventions were introduced in the 1993 Food Code that supplemented the other interventions long-established by the Food and Drug Administration (FDA) model codes and guidances to protect consumer health. The five key interventions are: Demonstration of Knowledge, Employee Health Controls, Controlling Hands as a Vehicle of Contamination, Time and Temperature Parameters for Controlling Pathogens, and the Consumer Advisory.

18 GUIDE 3-B Instructions for Marking the Food Establishment Inspection Report page 3 For each item on the inspection report form in the Foodborne Illness Risk Factors and Public Health Interventions section, the inspector should indicate one of the following for COMPLIANCE STATUS: IN which means that the item is in compliance; OUT which means that the item is not in compliance; N.O. which means that the item was not observed during the inspection; or N.A. which means that the item is not applicable for the facility. If N.A. or N.O. is not listed as an option for a particular item, this means that this item must be evaluated during the inspection and a compliance status must be determined. If the item is marked OUT, document details of each violation for the item number in the Observations and Corrective Actions section on the second page of the inspection report. Compliance status should be determined as a result of observations that establish a pattern of noncompliance. Consideration should be given to the seriousness of the observation with regard to prevention of foodborne illness. For items marked OUT, further indicate the status of the violation by marking an X in the corresponding box for Corrected On-Site (COS) during the inspection and/or Repeat violation (R). Marking COS indicates that all violations cited under that particular item number have been corrected and verified before completing the inspection. The actual corrective action taken for each violation should be documented in the Observations and Corrective Actions section of the inspection report. For example, Item #7 Handwashing sink is marked out of compliance because the establishment does not have soap and paper towels at the handwashing sink. The person in charge partially corrects the problem by putting soap at the sink, but does not replace the paper towels or provide any other effective means for drying hands. The corrective action taken for the soap is documented in the narrative on the form, but COS is not marked for Item #7 because all violations under that item were not corrected. Marking R indicates that the same violation under a particular item number was cited on the last inspection report. Using the same scenario, on the subsequent inspection if the provision of soap and paper towels is not in violation, but employees are not washing hands in the correct sink (which is also cited under Item #7 Handwashing sink), R would not be marked because this is a new violation which was not cited on the previous inspection report. C. MARKING INSTRUCTIONS FOR EACH RISK FACTOR AND INTERVENTION ON THE INSPECTION REPORT Supervision 1. PIC present, demonstrates knowledge, and performs duties IN/OUT This item must be marked IN or OUT of compliance. The person in charge (PIC) has three assigned responsibilities Presence; Demonstration of Knowledge; and Duties. This item is marked OUT of compliance if any one of the responsibilities is not met. A. Person in charge is present. This item is marked OUT of compliance if there is no PIC per (A) and (B). B. Demonstration of Knowledge. The PIC has three options for demonstrating knowledge. This item is marked OUT of compliance if the PIC fails to meet at least one of the options. The three options for demonstration of knowledge allowed by the Food Code are: 1. Certification by an ACCREDITED PROGRAM as specified in Complying with this Code by having no violations of priority items during the current inspection; or 3. Correct responses to the inspector's questions regarding public health practices and principles applicable to the operation. The inspector should assess this item by asking open-ended questions that would evaluate the PIC's knowledge in each of the areas enumerated in (C)(1), (4)-(16). Questions can be asked during the initial

19 GUIDE 3-B Instructions for Marking the Food Establishment Inspection Report page 4 interview, menu review, or throughout the inspection as appropriate. The Inspector should ask a sufficient number of questions to enable the inspector to make an informed decision concerning the PIC's knowledge of the Code requirements and public health principles as they apply to the operation. The dialogue should be extensive enough to reveal whether or not that person is enabled by a clear understanding of the Code and its public health principles to follow sound food safety practices and to produce foods that are safe, wholesome, unadulterated, and accurately represented. N.A. N.O. C. Duties of the PIC. This item must be marked IN or OUT of compliance based on the interaction and observation with the PIC and food employee. The inspector needs to determine the systems or controls the PIC has put into practice regarding oversight and/or routine monitoring of the Duties listed in This is accomplished by 1) discussion with the PIC, and 2) verified through observation that the systems or controls are actually being implemented. This concept is commonly referred to as Active Managerial Control. This item must be marked OUT of compliance when there is a pattern of non-compliance and obvious failure by the PIC to ensure employees are complying with the duties listed in Since marking this item out of compliance requires judgment, it is important that this item not be marked for an isolated incident, but rather for an overall evaluation of the PIC's ability to ensure compliance with the duties described in Do Not Mark this item N.A. Do Not Mark this item N.O. Applicable Code Section: Assignment (A), B) and (C)(1), (4)-(16) Demonstration (A)-(L) Person-In-Charge-Duties Employee Health 2. Management and food employee knowledge, and conditional employee; responsibilities and reporting. IN/OUT This item must be marked IN or OUT of compliance. This item is marked IN compliance when the following criteria are met: 1. The PIC is aware of his or her responsibility to inform food employees and conditional employees of their responsibility to report certain symptoms or diagnosed diseases to the person in charge and for the PIC to report to the regulatory authority as specified under Food Code (M) and (A),(B), (C), and (E); and 2. The PIC provides documentation or otherwise satisfactorily demonstrates during the inspection, that all food employees and conditional employees are informed of their responsibility to report to management information about their health and activities as it relates to diseases that are transmissible through food, as specified under (A). Satisfactory compliance may be documented by completion of Form 1-B, Conditional Employees or Food Employees Reporting Agreement, in Annex 7 of the 2009 Food Code for each employee or other similar State or local form containing the same information; or

20 GUIDE 3-B Instructions for Marking the Food Establishment Inspection Report page 5 3. In lieu of Form 1-B, compliance may be demonstrated by: a) Presenting evidence such as a curriculum and attendance rosters documenting that each employee has completed a training program which includes all the information required on Form 1-B regarding their reporting responsibilities; or b) Implementation of an employee health policy which includes a system of employee notification using a combination of training, signs, pocket cards, or other means to convey all of the required information on Form 1-B to all food employees and conditional employees. A signed acknowledgement by the employee should be part of any employee health policy. The regulatory authority is encouraged to establish a policy of selecting one employee at random during each inspection and requesting the PIC verify, by one of the previously listed methods, that the selected employee has been informed of his or her responsibility to report symptoms, exposures, and diagnosed illnesses to management. The PIC is not expected to quote symptoms and diseases from memory, but should be able to locate that information on Form 1-B or similar documents used to demonstrate compliance. N.A. N.O. Additional information is provided in Annex 3 of the Public Health Reasons for Subpart 2-201, including a number of questions, which may be used as a reference to assist the regulatory authority in determining compliance with this item. Do Not Mark this item N.A. Do Not Mark this item N.O (C)(2),(3) and (17) Demonstration (M) Person in Charge-Duties (A), (B), (C), & (E) Responsibility of Permit Holder, Person in Charge, and Conditional Employees 3. Proper use of restriction and exclusion IN/OUT This item must be marked IN or OUT of compliance. To be marked IN there must be no ill employees, employees experiencing symptoms requiring reporting, or reason for the PIC to exclude or restrict an employee observed at the time of the inspection. Compliance must be based on first hand observations or information and cannot be based solely on responses from the PIC to questions regarding hypothetical situations or knowledge of the Food Code. This item should be marked OUT of compliance when: The inspector observes a working employee with specific reportable symptoms (subparagraph (A)(1)); or The inspector becomes aware that an employee has reported information about his or her health and activities as it relates to diseases that are transmissible through food and the PIC has not acted to restrict or exclude an employee as required by the Food Code.( ) & ( ); or The inspector becomes aware that the PIC has not notified the Regulatory Authority that an employee is jaundiced or diagnosed with an illness due to a pathogen as specified under subparagraphs (A)(2)(a)-(e) of the Food Code. There are food employees working in the food establishment that have been diagnosed with Norovirus, hepatitis A virus, shigellosis, E.coli O157:H7, or other EHEC, or typhoid fever; or with active symptoms of vomiting and/or diarrhea; or working with food, foodcontact equipment, utensils, or single-service articles with an open, uncovered infected wound or pustule, or with a sore throat with a fever. Additionally, in food establishments

21 GUIDE 3-B Instructions for Marking the Food Establishment Inspection Report page 6 N.A. N.O. exclusively serving a highly susceptible population, there are to be no food employees with an active sore throat with a fever working in the food establishment. Do Not Mark this item N.A. Do Not Mark this item N.O (D) and (F) Responsibility of Permit Holder, Person in Charge, and Conditional Employees- Responsibility of the PIC to Exclude or Restrict Exclusions & Restrictions Removal, Adjustment, or Retention of Exclusions & Restrictions Good Hygienic Practices 4. Proper eating, tasting, drinking, or tobacco use IN/OUT This item should be marked IN or OUT of compliance based on direct observations or discussions of the appropriate hygienic practices of food employees. This item should be marked IN compliance when a food employee is observed drinking from a closed beverage container subsequently stored on a non-food-contact surface and separate from exposed food, clean equipment, and unwrapped single- service and single-use articles. This item should be marked OUT of compliance when food employees are observed improperly tasting food, eating, drinking, or smoking, or there is supporting evidence of these activities taking place in non-designated areas of the establishment. An open container of liquid in the kitchen preparation area does not necessarily constitute marking this item OUT. Further discussion with a food employee or the PIC may be needed to determine if the liquid, if labeled, is used as an ingredient in food, or may be an employee beverage that is consumed in another designated area. If the liquid is an open beverage that is consumed in a designated area, it must still be stored in a manner to prevent the contamination of food, equipment, utensils, linens and single-service/single-use articles. N.A. Do Not Mark this item N.A. N.O. This item may be marked N.O. for retail operations only in the RARE case when there are no food workers present at the time of inspection Eating, Drinking, or Using Tobacco Preventing Contamination When Tasting 5. No discharge from eyes, nose, and mouth IN/OUT This item should be marked IN or OUT of compliance based on direct observations of food employees. This item should be marked IN compliance when no food employees are observed having persistent coughing, sneezing, runny nose, or watery eyes. This item should be marked OUT of compliance when a food employee has persistent coughing, sneezing, runny nose, or watery eyes subjecting food and food-contact surfaces to potential contamination. N.A. Do Not Mark this item N.A. N.O. This item may be marked N.O. for retail operations only in the RARE case when there are no food workers present at the time of inspection Discharges from the Eyes, Nose, and Mouth

22 GUIDE 3-B Instructions for Marking the Food Establishment Inspection Report page 7 Control of Hands as a Vehicle of Contamination 6. Hands clean and properly washed IN/OUT This item should be marked IN or OUT of compliance. This item is marked IN compliance only when employees are observed using proper handwashing techniques at appropriate times and places. N.A. Do Not Mark this item N.A. N.O. This item may be marked N.O. for retail operations only in the RARE case when there are no food workers present at the time of inspection. (If there are no food workers present, but the PIC accompanies the inspector on the inspection and touches food, clean equipment, or utensils without washing his/her hands, this item is marked OUT.) Clean condition-hands and Arms Cleaning Procedure When to Wash Where to Wash Hand Antiseptics 7. No bare hand contact with RTE foods or a pre-approved alternate properly followed IN/OUT This item should be marked IN or OUT of compliance. This item is marked IN compliance only when employees are observed using suitable utensils or gloves to prevent bare hand (or arm) contact with ready-to-eat foods or are observed properly following a pre-approved alternative procedure to no bare hand contact. This item should be marked OUT of compliance if one person is observed touching ready-to-eat food with their bare hands in the absence of a prior approval and written procedures for bare hand contact. Refer to subparagraph (D)(1)-(7) for a listing of conditions that must be met in order to receive prior approval by the Regulatory Authority. Bare hand contact by food employees serving a Highly Susceptible Population is prohibited and no alternative to bare hand contact is allowed. N.A. This item may be marked N.A. for establishments that provide only packaged, or bulk food items that are not ready-to-eat. N.O. This item may be marked N.O. for establishments that prepare ready-to-eat foods only, but no food preparation is performed at the time of inspection Preventing Contamination from Hands (D) Pasteurized Foods, Prohibited Re-Service, and Prohibited Foods 8. Adequate handwashing sinks, properly supplied and accessible IN/OUT This item must be marked IN or OUT of compliance based on observations in determining that handwashing sinks are properly equipped and conveniently located for food employee use. This item must be marked OUT of compliance when the facility is not stocked with soap, hand drying provisions or equipped with the required signage. In addition, if the handwashing sink is not located to be available to food employees who are working in food preparation, food dispensing and warewashing areas, is blocked by portable equipment or stacked full of soiled utensils or other items, or the facility is unavailable for regular employee use, this item must be marked OUT of compliance. N.A. Do Not Mark this item N.A. N.O. Do Not Mark this item N.O Handwashing Sinks, Installation Handwashing Sinks-Numbers and Capacities