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Restrict/Exclude food service workers when ill when working with a Highly Susceptible Population Base

Question: I’m a new foodservice manager in a health care facility, I’m not sure I understand what the difference is between restricting and excluding the foodservice employee, can you help?

Answer:  Chapter 1 – Purpose and Definitions

“Restrict” means to limit the activities of a food employee so that there is not risk of transmitting a disease through food and the food employee does not work with exposed food; clean equipment; utensils; linens; or unwrapped single-service or single-use articles.

“Exclude” means to prevent a person from working as an employee in a food establishment or entering a food establishment as an employee.

Restrictions and exclusions vary according to the population served because highly susceptible populations have increased vulnerability to foodborne illness. For example, foodborne illness in a healthy individual may be manifested by mild flu-like symptoms. The same foodborne illness may have serious medical consequences in immunocompromised individuals. This point is reinforced by statistics pertaining to deaths associated with foodborne illness caused by Salmonella Enteritidis. Over 70% of the deaths in outbreaks attributed to this organism occurred among individuals who for one reason or another were immunocompromised. This is why the restrictions and exclusions listed in the Code are especially stringent for food employees serving highly susceptible populations.

Periodic testing of food employees for the presence of diseases transmissible through food is not cost effective or reliable. Therefore, restriction and exclusion provisions are triggered by the active gastrointestinal symptoms, followed by diagnosis and history of exposure.

The history of exposure that must be reported applies only to the 5 organisms listed.       

Reporting History of Exposure:

The reporting requirements for history of exposure are designed to identify employees who may be incubating an infection due to Norovirus, Shigella spp., E. coli O157:H7 or other EHEC/STEC, typhoid fever, or HAV (Hepatitis A Virus).

Which employees who report exposure are restricted?

  • Employees who work in a food establishment serving a highly susceptible population (HSP) facility.

What constitutes exposure?

  • Consuming a food that caused illness in another consumer due to infection with Norovirus, Shigella spp., E. coli O157:H7 or other EHEC/STEC, typhoid fever,or HAV   
  • Attending an event or working in a setting where there is a known disease outbreak.   
  • Close contact with a household member who is ill and is diagnosed with a listed pathogen.

Upon being notified of the history of exposure, the person in charge should immediately:

  • 1. Discuss the traditional modes of transmission of fecal-oral route pathogens.   
  • 2. Advise the food emploee to observe good hygienic practices both at home and at work. This includes a discussion of proper handwashing, as described in the Code, after going to the bathroom, changing diapers, or handling stool-soiled material.   
  • 3. Review the symptoms listed in the Code that require immediate exclusion from the food establishment.   
  • 4. Remind food employees of their responsibility as specified in the Code to inform the person in charge immediately upon the onset of any of the symptoms listed in the Code.   
  • 5. Ensure that the food employee stops work immediately if any of the symptoms described in the Code develop and reports to the person in charge.

In order to comply with Title I of the Americans with Disabilities Act, anexclusion must also be removed if the employee is entitled to a reasonable accommodation that would eliminate the risk of transmitting the disease. Reasonable accommodation may include reassignment to another position in which the individual would not work around food. The steps an employer must take when an excluded employee requests reasonable accommodation are briefly described in Annex 3, § 2-201.11. However, it is not possible to explain all relevant aspects of the ADA within this Annex. When faced with an apparent conflict between the ADA and the Food Code’s exclusion and restriction requirements, employers should contact the U.S. Equal Employment Opportunity Commission.

A restricted food employee may work in an area of the food establishment that houses packaged food, wrapped single-service or single-use articles, or soiled food equipment or utensils. Examples of activities that a restricted person might do include working at the cash register, seating patrons, bussing tables, stocking canned or other packaged foods, or working in a non-food cleaning or maintenance capacity consistent with the criteria in the definition of the term “restricted.” A food employee who is restricted from working in one food establishment may not work in an unrestricted capacity in another food establishment, but could work unrestricted in another retail store that is not a food establishment. A restricted food employee may enter a food establishment as a consumer.

An excluded individual may not work as a food employee on the premises of any food establishment.


This information is provided as a general guideline and is not intended to be, nor does it, constitute legal or regulatory advice. Additional Federal regulations may apply to your particular circumstances. State, regional and local laws, ordinances and regulations may also apply.