EFH-R_Food Employee Health Agreement

Code EFH-R

FOOD EMPLOYEE HEALTH AGREEMENT

Sublette County School District #9

It is recommended that this document be used as an agreement between employees and administration to help ensure that Food Service Employees notify the Food Service Manager when they experience any of the symptoms listed below. The Food Service Manager will then take appropriate steps to prevent the transmission of foodborne illness. The use of this document should help demonstrate to the regulatory authority that there is an Employee Health Policy in place.

I AGREE TO IMMEDIATELY REPORT TO THE FOOD SERVICE MANAGER ANY OF THE FOLLOWING SYMPTOMS:

· Diarrhea

· Fever

· Vomiting

· Jaundice

· Sore throat with fever

MEDICAL DIAGNOSIS:

Whenever diagnosed as being ill with Salmonellosis (salmonella spp.), Shigellosis (Shigella spp.), Shiga toxin-producing E. coli, Hepatitis A (hepatitis A virus), or any other pathogen that can be transmitted through food such as : Entameoba histolytica, Camphylobacter sup, Norovirus, Cryptosporidium spp., Giardia spp., Yersinia enterocolitica, Staphylococcus aureus, or Listeria moncytogenes.

I have read and understand my responsibilities regarding the Food Service Employee Health Policy to comply with:

1. Reporting requirements specified above involving symptoms and diagnosis.

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 actions by the district that may result in termination of employment and may involve legal action against me.

Food Service Employee Name (print) ___________________________________________

_______________________________________________________________________________

Food Service Employee Signature Date

_______________________________________________________________________________

Food Service Director Signature Date

EFH-R_Food Employee Health Agreement Policy.pdf