Food Workere Informed Consent and Electronic Survey

Environmental Health Specialists Network Information System (EHSNIS)

Environmental Health Specialists Network Information System (EHSNIS)

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Study Definition Tester
This page is provided for testing only. Supply an answer for each question. When finished click 'Submit'.
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Study Definition:

EHSNet Food Safety Culture

Data Collection Form:

Food Worker Survey - Electronic

EHS:

adamkramer

EHS-Net Food Safety Practices and Beliefs Study
Form Approved
OMB No. 0920-0792
Exp. Date 9/30/2018
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Your restaurant was chosen at random to be in a research project on food worker beliefs and practices, and
your manager agreed that it would be okay for you to fill out this form. However, your participation is
voluntary - you do not have to fill out this form if you do not want to - we will not inform your manager. If you
do fill out the form, your manager will not see it.
The information that you provide will be combined with information from other restaurants in various states.
Your name and your restaurant's name will not be linked in any way to the information we collect nor will they
be included in any reports.
The information you provide will be valuable in helping us understand the difficult issues that restaurants face
so we ask you to be as open and honest as possible.
If you agree to participate please complete the questions on the following pages. If you would not like to
participate, you can exit now. You may skip any questions that you do not want to answer.
CDC estimates the average public reporting burden for this collection of information as 10 minutes per
response, including the time for reviewing instructions, searching existing data/information sources,
gathering and maintaining the data/information 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 to: CDC/ATSDR Information Collection Review Office, MS D-74, 1600 Clifton Road NE, Atlanta, GA,
30333, ATTN:PRA (0920-0792).
*1 Please enter the ID number provided on the survey link/flyer to continue or you can choose not to
participate and close this screen.

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https://wwwn.cdc.gov/EHSNet/private/em/_reviewquestionnaire.aspx

Environmental Health Specialists Network Information System (EHSNIS)

Please indicate how much you agree with the following statements based on your experiences in this
restaurant. These responses cannot be linked back to you, so please be as honest as possible.
2 Employees follow food safety rules, even when no one is looking
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
3 Employees encourage each other to follow food safety rules
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
4 Employees take responsibility for food safety in their areas
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
5 Employees wash their hands when they are supposed to
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
6 Employees touch food that will not be cooked with their bare hands
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
7 Employees do not work while they are sick with vomiting or diarrhea
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
8 There are enough gloves or utensils to use to avoid touching the food with my bare hands
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
9 Sinks are nearby and are easy to get to for handwashing
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
10 Sinks for handwashing have hot water, soap, and paper towels or another way to dry my hands
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
11 Equipment is well maintained and operates properly
Strongly disagree

https://wwwn.cdc.gov/EHSNet/private/em/_reviewquestionnaire.aspx

Environmental Health Specialists Network Information System (EHSNIS)

Disagree
Neither Agree nor Disagree
Agree
Strongly agree
12 There is enough staff to cover when the restaurant is busy
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
13 There is enough staff to cover when an employee does not come in to work
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
14 Employees have to cut corners because there is too much work to do
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
15 Managers encourage employees to follow food safety rules
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
16 When the restaurant is busy, managers prioritize serving food over following food safety rules
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
17 Managers encourage employees to report food safety problems
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
18 Managers ignore when employees are not following food safety rules
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
19 Managers are aware of the food safety rules
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
20 Managers strive to improve food safety practices
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
21 If food safety rules are not followed a customer may become sick

https://wwwn.cdc.gov/EHSNet/private/em/_reviewquestionnaire.aspx

Environmental Health Specialists Network Information System (EHSNIS)

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Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
22 The restaurant provides sufficient food safety training for me to do my job
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
23 I know what the food safety rules are for my job
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
24 Food safety is stressed with signs, posters, or in shift meetings
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
25 Employees are positively recognized for following food safety rules
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
26 Managers get feedback from employees to improve food safety
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
27 Employees know the restaurant’s food safety expectations
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
28 My manager explains what is expected of me
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
29 It is easy to talk with my manager about any problems
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
30 Unsafe food always smells or looks bad
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree

https://wwwn.cdc.gov/EHSNet/private/em/_reviewquestionnaire.aspx

Environmental Health Specialists Network Information System (EHSNIS)

31 It is okay to eat undercooked or raw meats as long as they are organic
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
32 It is okay to eat undercooked or raw meats as long as they are local
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
33 Eating raw or undercooked meats increases your risk for illness
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
34 Food that has been cooked and then refrigerated can continue to be used until it looks or smells bad
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
35 Once cooked, food no longer has any bacteria on it
Strongly disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly agree
36 The warning statements on some menus about eating raw or undercooked food is there because (check all
that apply):
The government requires it
The restaurant is trying to avoid responsibility if someone gets sick
The restaurant wants to let customers know which items may be riskier to eat
I haven't seen a warning on any menus
Other (Describe):_______
36a Please describe:

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37 Our restaurant serves undercooked or raw meats (such as runny eggs, rare steak, or raw fish) when (check
all that apply):
A customer orders their food prepared that way
The chef feels that it is the proper way to serve the menu item
We don't serve raw or undercooked meats
Other (Describe):_______
37a Please describe

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38 Our restaurant lets customers know that eating meat that is raw or undercooked increases their risk for
illness (check all that apply):
We don't serve raw or undercooked meats
By a written warning on the menu
By identifying the items on the menu with an asterisk or other symbol
Verbally when a customer orders their food undercooked or raw
By a written sign
We don't remind them
Other (Describe):_______

https://wwwn.cdc.gov/EHSNet/private/em/_reviewquestionnaire.aspx

Environmental Health Specialists Network Information System (EHSNIS)

38a Please describe

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Please answer the next questions to the best of your knowledge. Some of the practices asked about may not
occur in this restaurant.
39 Our restaurant cooks and then cools down a meat product (such as chicken) for later service on March 15.
When must it be used by? (pick one)
It doesn't matter it has been cooked
March 18
March 19
March 20
March 21
March 22
March 23
Other (Describe):_______
39a Please describe

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40 Our restaurant opens a package of deli meat on Tuesday. When must it be used by? (pick one)
It doesn't matter, it has already been cooked
Wednesday
Thursday
Friday
Saturday
Sunday
Monday
Following Tuesday
41 Hands should be washed prior to handling food, plates or utensils after (check all that apply)
They only need to be washed before handling food not before handling plates or utensils
If an employee uses gloves they don't need to wash their hands
Using the toilet
Between handling raw and cooked foods
Coughing or sneezing into their hand
42 Cold held meats or other refrigerated items should be kept at ____ or below (pick one)
32F (0C)
41F (5C)
45F (7C)
50F (10C)
43 Hot held meats or other hot items should be kept at ____ or higher (pick one)
120F (49C)
135F (57C)
140F (60C)
150F (66C)
44 What symptom(s) are most likely to show that an employee has an illness that can be passed through food
(pick one)
Pink eye
Runny nose and sneezing
Vomiting and diarrhea
All of the above
45 What is the proper procedure for washing your hands (pick one)
Wet hands with warm water. Apply soap. Vigorously scrub hands and arms for 10-20 seconds. Rinse
hands. Dry hands.
Wet hands with warm water. Apply soap. Vigorously scrub hands and arms for 2-5 seconds. Apply a hand
antiseptic (such as hand santizer.) Dry hands.
Wet hands with warm water. Apply soap. Rinse hands. Dry hands.
None of the above

https://wwwn.cdc.gov/EHSNet/private/em/_reviewquestionnaire.aspx

Environmental Health Specialists Network Information System (EHSNIS)

46 Food that is cooked and then cooled must be cooled down within the following timeframe (pick one):
135F/140F to 70F within 2 hours and then reach 41F/45F within an additional 4 hours (6 hours total)
135F/140F to 70F within 4 hours and then reach 41F/45F within an additional 8 hours (12 hours total)
135F/140F to 41F/45F within 4 hours
135F/140F to 41F/45F within 6 hours
It doesn’t matter if the food has been cooked thoroughly
None of the above
47 The proper order for dishwashing (either manually in a three-compartment sink or using a dishwasher) is
(pick one):
Rinse, wash with soapy water, sanitize, air dry
Wash with soapy water, rinse with clean water, sanitize, air dry
Wash with soapy water, sanitize, towel dry
None of the above
DEMOGRAPHIC / CLASSIFICATION
48 How many years have you worked in food service? [Check only one]
less than 1 year
1-5 years
6-10 years
11-15 years
More than 15 years
Prefer not to answer
49 Have you had any food safety training while employed at this restaurant?
Yes
No
Prefer not to answer
50 Have you ever been certified in food safety?
Yes
No
50a Is the certification still valid?
Yes
No
51 Have you ever been a Certified Food Protection Manager (such as by passing an ANSI accredited program
such as ServSafe, Prometric, National Registry of Food Safety Professionals, 360Training, or AboveTraining)?
Yes
No
51a Is the certification still valid?
Yes
No
52 How long have you been employed at this restaurant? [Check only one]
less than 1 year
1-5 years
6-10 years
11-15 years
More than 15 years
53 What area of the kitchen do you primarily work in? [Check only one]
Cook line
Food prep
Cook line & Food prep
Serving
Bar
Dishwashing
Supervision
Other (Describe):_______
53a Please describe

https://wwwn.cdc.gov/EHSNet/private/em/_reviewquestionnaire.aspx

Environmental Health Specialists Network Information System (EHSNIS)

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54 What is your gender?
Male
Female
Prefer not to answer
55 What is the highest level of formal education you have completed?
8th grade or less
Some high school
High school diploma/GED
Some community college
Community college or associate degree
Some college
Bachelors Degree
Some graduate school
Graduate degree
Other (Describe):_______
Prefer not to answer
55a Please describe

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56 Have you attended a culinary training or culinary arts program?
Yes - Completed the program
Yes - Have taken courses but did not complete the program or I am currently taking classes
No
57 What is your primary language (the language that you speak best)?
English
Spanish
Russian
Chinese (any dialect)
Japanese
Vietnamese
Korean
German
Italian
Polish
Other (Describe):_______
Prefer not to answer
57a Please describe

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Content source: National Center for Environmental Health

Centers for Disease Control and Prevention 1600 Clifton Rd. Atlanta, GA 30333, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, 24 Hours/Every Day - [email protected]

https://wwwn.cdc.gov/EHSNet/private/em/_reviewquestionnaire.aspx