Form Approved
OMB No. 0920-0792
Exp. Date 10/31/2011
Attachment 6- EHS-Net KMC Study Data Collection Instrument: Worker Interview
________________________________________________________________________________
Only bold text is to be read aloud by the data collector. Instructions to data collector are italicized.
Food Preparation Cleaning
Cooking Other (describe) ______________________________
Food storage Unsure
Washing dishes Refused
2 Approximately how long have you worked in the foodservice industry? ______ Unsure Refused
3. Approximately how long have you worked as a food worker here? ______ Unsure Refused
Now I am going to ask you a few questions about food safety training.
While employed here, have you received food safety training on topics such as how to prevent cross contamination or how to do a proper hand wash?
Yes (go to 5) No (go to 8) Unsure (go to 8) Refused (go to 8)
4a. Who conducted that training? (Check all that apply)
Management
Owner Other (describe) _________________________________
Supervisor Unsure
Co-worker Refused
5. Did the training include any of the following?
a…Classroom training Yes No Unsure Refused
b…On-the-job training in the restaurant Yes No Unsure Refused
c…Online training Yes No Unsure Refused
d…A manual or employee handbook Yes No Unsure Refused
e…other kinds of written materials Yes No Unsure Refused
Public reporting burden for this collection of information is
estimated to average 10 minutes per response, including
the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information. An agency may not
conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB
control number. Send comments regarding this burden estimate or any
other aspect of this collection of information, including
suggestions for reducing this burden, to: CDC/ATSDR Information
Collection Review Office, MS D-74; 1600 Clifton Road NE, Atlanta,
Ga. 30333; ATTN: PRA (0920-0792)
6. Did the food safety training include instruction on:
a. How, when, and where to do a hand wash?
Yes No N/A Unsure Refused
b. How and when to use gloves to prevent contamination of foods?
Yes No N/A Unsure Refused
c. Time and temperature control of potentially hazardous foods?
¦ Yes ¦ No ¦ N/A ¦ Unsure ¦ Refused
d. How to properly clean and sanitize equipment and food contact surfaces?
Yes No N/A Unsure Refused
e. How to prevent or reduce the risk of cross contaminating food during storage, preparation, holding and service?
Yes No N/A Unsure Refused
f. How to use a thermometer to check food temperatures?
Yes No N/A Unsure Refused
g. Final cook temperatures of potential hazardous foods?
Yes No N/A Unsure Refused
7. Did you find the training very useful, somewhat useful, not very useful, or not useful at all? (Show scale on last page)
m Very useful m Somewhat useful m Not very useful m Not useful at all Unsure Refused
Do you think it’s important to handle food safely? (Show scale)
m Yes, definitely m Yes, sort of m Not sure m No, not really m No, not at all m Refused
Do your co-workers think it’s important to handle food safely? (Show scale)
m Yes, definitely m Yes, sort of m Not sure m No, not really m No, not at all m Refused
10. Does your boss/owner think it’s important to handle food safely? (Show scale)
m Yes, definitely m Yes, sort of m Not sure m No, not really m No, not at all m Refused
Are you food safety certified? By certified I mean you have taken a test written by a national testing organization and been issued a card with an expiration date on it? (Check “No” if the certification is expired)
Yes (go to 11a) No (go to 12) Unsure (go to 12) Refused (go to 12)
11a. What organization provided the certification ServSafe, National Registry of Food Safety Professionals, Thomson Prometric, a state or local health department, or some other organization? (Check all that apply)
ServSafe
National Registry of Food Safety Professionals
Thomson Prometric (formerly known as: Experior Assessments, National Assessment Institute, Chauncy, Educational Testing Service)
A state or local health department
Other, describe:___________________________________________
Unsure
Refused
For the following statements, please tell me if you think the statement is correct by saying Yes, No, or Not Sure.
a. The best way to dry your hands after hand washing is with paper towels.
Yes No Unsure Refused
b. It’s okay to thaw frozen raw chicken on the counter at room temperature.
Yes No Unsure Refused
c. Hamburger patties should be cooked for at least fifteen seconds at a temperature of 155 degrees Fahrenheit or higher.
Yes No Unsure Refused
d. During hand washing, food workers must scrub their hands and arms for 4 or 5 seconds.
Yes No Unsure Refused
e. Food workers have to wash hands between glove changes.
Yes No Unsure Refused
f. Wiping cloths used to clean food spills should be stored in a sanitizer solution.
Yes No Unsure Refused
g. Food held hot on a steam table should be maintained at 160 degrees Fahrenheit or higher.
Yes No Unsure Refused
Yes No Unsure Refused
8th grade or less m Community college/associate degree m Graduate degree
Some high school m Some college m Other ____________
High school diploma m College degree m Unsure
Some community college/associate work m Some graduate work m Refused
Please indicate which of the following categories best describes your age—15 to 20 years of age, 21 to 30 years of age, 31 to 40 years of age, 41 to 50 years of age, 51 to 60 years of age, or older than 60?
15 to 20 years of age m 51 to 60 years of age
21 to 30 years of age m Older than 60
31 to 40 years of age m Unsure
41 to 50 years of age m Refused
15. What is your primary language? (If respondent needs clarification—primary language is the language you speak best)
English m Other (describe)_____________________________________
Spanish m Unsure
Russian m Refused
An Asian language
NOT TO BE READ ALOUD: Note the interviewee’s gender here: m Male m Female
That’s the end of the interview. Thank you for your time.
| File Type | application/msword |
| Author | lrg |
| Last Modified By | sds2 |
| File Modified | 2011-03-18 |
| File Created | 2010-08-19 |