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C.) 1.) If I am the suspected cause of, or exposed to a confirmed disease outbreak; 2) Attend or work in a

setting where there is a confirmed disease outbreak; 3) Live in the same household with a person diagnosed or

4) Live in the same household with a person who attends or works in a setting of a confirmed outbreak of any of

the following:

1. Norovirus within the past forty-eight hours of the last exposure.

2. Shiga toxin-producing Escherichia coli, or Shigella spp. within the past three days of the last exposure.

3. Salmonella Typhi within the past fourteen days of the last exposure.

4. Hepatitis A within the past thirty days of the last exposure.

The PIC must ensure that a conditional employee:

1. Is prohibited from becoming a food employee until exclusions or restrictions are removed if they exhibit

the symptoms or are diagnosed with any of the illnesses that were listed previously.

2. Is prohibited from becoming a food employee in an operation that serves a highly susceptible

population (define highly susceptible) until exclusions or restrictions are removed if they report a high risk

condition or any of the illnesses listed in the previous paragraph.

The PIC shall restrict the duties of a food employee that exhibits any of the previously listed

symptoms.

The PIC shall restrict the duties of, or exclude a food employee from the operation if they have been

diagnosed with any of the thirteen previously listed illnesses.

The PIC may remove an exclusion or restriction due to an illness diagnosis if the food employee is

released by a healthcare provider or approved by Franklin County Public Health. The PIC may

remove a restriction if it was due to previously listed symptoms, if the symptoms have ceased and the

symptoms were not from one of the thirteen previously listed illnesses.

Exclude means to prevent the employee from working in the operation or entering the operation as

an employee.

Restrict means to prevent the employee from working with clean equipment, utensils, linens or

unwrapped single-service articles.

I have read (or had explained to me) and understand the requirements concerning my responsibilities under

the Ohio Uniform Food Safety Code. I understand that failure to comply with the terms of this agreement could

lead to action by my employer or Franklin County Public Health that may impact my employment or involve

legal action against me.

Conditional Employee Name (print) _________________________________________

Signature of conditional Employee __________________________________________

Date __________________

Food Employee Name (print) _______________________________________________

Signature of Food Employee ________________________________________________

Date __________________

Signature of Permit Holder or PIC ____________________________________________

Date __________________

*For more information, please visit or call the Food Safety Program at (614) 525-3160*

Rev. 1/2016

Food Employee Or Conditional Employee Reporting Agreement - Franklin County Public Health Page 2