Manager Consent and Interview

Attachment 5 – Assessment of Ill Worker Policies Study: Manager Informed Consent and Interview Form

___________________________________________________________________________________________

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/xxxx

Only bold text is to be read aloud by the data collector. Instructions to data collector are italicized. Responses with boxes (☐) can have multiple responses and single answers have circles ().

MANAGER INFORMED CONSENT

Let me tell you why I am here. I am working with ______________________(state/local health department) on a project looking at ill worker management practices in restaurants. Past research has shown that restaurant workers have reported working while sick and we are looking to see what current practices are in place to keep them from potentially contaminating the food or restaurant. Your restaurant was picked at random to be a part of this project. Participation is voluntary. You can choose to stop at any time. Whether you are a part of the study will not affect your restaurants rating on any health inspection.

CDC estimates the average public reporting burden for this collection of information as 20 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-xxxx).

Having said that I need to let you know that if at any time during my visit I see something that is an imminent health hazard, such as no power or water, or sewage backing up in the restaurant, I will need to stop what I am doing and report the problem to your local health department.

I am going to ask you some questions about your restaurant and its ill worker procedures. If any of the questions make you uncomfortable, you can choose not to answer them. The information I collect today will be combined with information from other restaurants in other states. While I do have your restaurant name and address, it will remain with me and be destroyed at the end of the study. The data we collect will only be reported with a coded identifier that will not be provided to anyone else.

The information you provide will be valuable in understanding some of the tough issues that restaurants face, so we ask you to be as open and honest as you can.

For intervention restaurants introducing the toolkit

The interview portion should take approximately 20 minutes. After the interview, I would like to provide you with a toolkit for developing or enhancing your current ill worker policies and explain a bit about how you may use it. This should take no more than 30 minutes. I also would like to provide this survey to your workers, they can fill it out at their leisure and it should take less than 5 minutes to get their perspectives. I would then like to take a short tour of the kitchen.

For control restaurants or follow up of intervention restaurants

The interview portion should take approximately 20 minutes. After the interview, I also would like to provide this survey to your workers, they can fill it out at their leisure and it should take less than 5 minutes to get their perspectives. I would then like to take a short tour of the kitchen.

For all restaurants

I appreciate your time and will be following up in 3-6 months with you to see if there have been any changes in the restaurants practices.

Do you have any questions? If you have any questions at a later time or would like a summary of the study’s findings, you can contact: (Local contact name). We expect to have all of the data summarized in about a year and a half.

DEMOGRAPHIC / CLASSIFICATION

I’d like to ask you some questions about yourself and this restaurant. Please be as open and honest as possible, the results will be merged with information from other restaurants and no specific identifying information from this restaurant will be reported. The first few questions are about your experience?

1. How many years have you worked in food service?

 Less than 1 year 1-5 years  6-10 years  11-15 years  More than 15 years

2. Have you ever had food safety training?

 Yes  No

3. Have you ever been certified in food safety (such as with the ServSafe® Food Safety Manager course)?

 Yes  No If yes, is the certification still valid?  Yes  No

4. How long have you been employed at this food service establishment?

 Less than 1 year 1-5 years  6-10 years  11-15 years  More than 15 years

5. What title would best describe your position?

 General Manager Assistant Manager  Kitchen Manager  Owner  Shift Supervisor  Other:______________________

6. Does the restaurants food safety performance, such as inspection scores, affect your compensation?

 Yes No  Unsure  Refused

MANAGER BELIEFS

I would now like to provide you with a few statements and get your opinion on how well you agree or disagree with them, there is no right or wrong answer, we would just like to get your opinion. For these statements please answer on a scale of 1 – completely disagree to 5 – completely agree.

7. In your opinion, sick workers sick workers can transmit their illness through food.

 Score _________ (1 – Completely disagree – 5 – Completely agree  Unsure  Refused

8. An employee calling in sick creates a minor problem for the running of my restaurant.

 Score _________ (1 – Completely disagree – 5 – Completely agree  Unsure  Refused

9. If employees wash their hands more than normal it is okay to work while sick.

 Score _________ (1 – Completely disagree – 5 – Completely agree  Unsure  Refused

10. Employees call in sick because they want a day off, not because they are actually ill.

 Score _________ (1 – Completely disagree – 5 – Completely agree  Unsure  Refused

11. If we cook the food it will destroy any germs on the food that may have come from a sick worker.

 Score _________ (1 – Completely disagree – 5 – Completely agree  Unsure  Refused

12. There is no risk from an ill worker handling a plate or food once it has been cooked.

 Score _________ (1 – Completely disagree – 5 – Completely agree  Unsure  Refused

RESTAURANT DEMOGRAPHIC / CLASSIFICATION

Now, I’d like to ask some general questions about this restaurant.

13. Which of the following options best describes the restaurant style?

 Family Style  Fast Casual  Fast Food  Fine Dining  Buffet  Café/Bistro  Other _______________________________________

14. What is your approximate sales per customer?

 Sales/head $_______  Unsure  Refused

15. What is your average number of transactions or tickets per day?

 Transactions _________  Unsure  Refused

16. Approximately how many meals do you serve on an average day?

 Meals: _________  Unsure  Refused

17. How many people work here including employees and managers?

 Total staff: _________  Unsure  Refused

18. What is your average rate of employee turnover per month?

 Turnover _________  Unsure  Refused

19. In general, what is the average length of employment for:

1. Managers: _______yr / mo  Unsure  Refused

2. Cooks: _______ yr / mo  Unsure  Refused

20. How often do you review the restaurant’s profit and loss statement?

 Daily  Weekly  Monthly  Annually  Never  Unsure of frequency  Doesn’t know what this is  Refused

21. How often do you review the restaurant’s prime costs? (Total cost of goods sold + total labor cost)

 Daily  Weekly  Monthly  Annually  Never  Unsure of frequency  Doesn’t know what this is  Refused

22. Is the manager over the kitchen a Certified Kitchen Manager?

 Yes No  Unsure  Refused If yes, is the certification still valid?  Yes  No

23. Does this restaurant allow employees to handle ready to eat foods with their bare hands?

 Yes  No  Unsure  Refused  Mark if bare hand contact is allowed by regulatory

24. Does the restaurant have a Certified Kitchen Manager for all hours of operation?

 Yes No  Unsure  Refused

ILL WORKER POLICY

I would now like to ask you some questions about what this establishment does if an employee is ill.

25. Are you able to ask employees about any illness symptoms or diagnoses they may have?

 Yes No  Unsure  Refused

26. Does this restaurant have a policy about what to do if an employee is sick?

 Yes No  Unsure  Refused If yes →Continue to question 27, Else go to Question 34

27. Is the policy written or verbal?

☐ Written ☐Verbal ☐ Unavailable ☐ Unsure ☐ Refused

28. Are employees trained on this policy?

 Yes No  Unsure  Refused If No, Unsure, Refused → Go to question 30

29. How are employees trained on the policy?

☐ Posted policies ☐Provided with policy manual ☐Part of initial training ☐from co-workers ☐Other__________________________________________________ ☐ Unsure ☐ Refused

30. What symptoms or illnesses does the policy cover and what actions do you take?

Interviewer mark the right two boxes if there is a local requirement for the specific provision and if they are in compliance with the provision – If they have a written policy you can read the policy and fill in the table.

Condition	Yes	No	Exclude or Restrict	Mark if it is a requirement	Mark if they are in compliance with requirement
Vomiting			E R
Diarrhea			E R
Jaundice (yellowish skin and eyes)			E R
Sore throat with a fever			E R
Lesions containing pus			E R
Cough			E R
Cold			E R
Hepatitis A			E R
Typhoid Fever			E R
Non-typhoidal Salmonella			E R
Shiga-toxin producing E. coli			E R
Norovirus			E R
Shigella spp			E R
Other:			E R
Other:			E R
Other:			E R
Other:			E R
Other:			E R

31. If you send an employee home or they call in sick what criteria do you use to let them return to work?

☐ Employee’s decision ☐ 24 hrs symptom free ☐ 48 hrs symptom free ☐ >48 hrs symptom free ☐ Consult regulatory authority ☐ Doctor’s note ☐ Refer to food code/regulatory handout ☐ Other: _____________________________________ ☐ Unsure ☐ Refused

32. Who does this policy apply to? If All employees → go to question 34

☐ All employees ☐Kitchen staff ☐ Front of house staff ☐ Managers ☐ Unsure ☐ Refused

33. What are the differences between the groups? (follow up from above question)

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

34. Do you require employees to let you know when they are sick?

 Yes  No  Unsure  Refused  Employee Reporting Agreement  Other:___________________

35. Does the restaurant maintain a log of when employees call in sick or are sent home sick? If available ask to see the log and mark the checkbox for verified

 Yes  No  Unsure  Refused  Verified

36. Approximately how many employees have you had that were out sick over the past month?

Number of ill employees:_______  Unsure  Refused

37. Do you actively look for signs or symptoms of illness in your employees?

 Yes  No  Unsure  Refused If No → go to question 39

38. What symptoms do you look for?

☐ Cough ☐ Sneezing ☐ Vomiting ☐ Diarrhea ☐ Frequent trips to restroom ☐ Fever ☐ Pink eye ☐ Runny nose ☐ Lesions ☐ Malaise ☐ Other: _____________________________________________

39. When you hire a new employee do you ask about prior illnesses?

 Yes  No  Unsure  Refused

ILL WORKER PRACTICES

I would now like to ask you about how you manage the restaurant when an employee is ill.

40. What do you do if an employee calls in sick?

☐ Work short-staffed ☐ Manager fills in for employee ☐ Employee has to find replacement ☐ Manager finds replacement ☐ Varies on position: ________________________________________ ☐ Other: __________________________________________________________☐ Unsure ☐ Refused

41. Do you have any processes or procedures in place to keep ill workers from working?

 Yes  No  Unsure  Refused If No, Unsure, Refused → go to question 43

42. What processes or procedures have you implemented?

Interviewer mark the right two boxes if there is a local requirement for the specific provision and if they are in compliance with the provision.

Process	Yes	No	Mark if it is a requirement	Mark if they are in compliance with requirement
Paid sick leave
On-call employee schedule
Employer-paid immunizations (e.g. Hepatitis A)
Subsidized health insurance
Letting employees make up shifts
Other:
Other:
Other:

43. Who in the restaurant would be able to make changes to this restaurants ill worker policy?

☐ Owner ☐ General manager ☐ Corporate office ☐ Other: __________________________________ ☐ Unsure ☐ Refused  Is this the person being interviewed

44. In your opinion, which of the following processes would be most likely to be adopted by this restaurant?

☐ Paid sick leave or additional paid sick leave if you already provide sick leave

☐ Maintaining an on-call employee schedule

☐ Paying for employee immunizations

☐ Subsidizing employee health insurance

☐ Allowing employees to make up missed shifts

☐ None ☐ Unsure ☐ Refused

CLEANING PRACTICES/GOOD HYGIENIC PRACTICES

I would now like to ask a some questions about your cleaning procedures.

45. Do you have written policies for cleaning of the facility?

 Yes  No  Unavailable  Unsure  Refused

46. Does the policy differentiate between routine cleaning and whether a bodily fluid is spilled?

 Yes  No  Unsure  Refused

47. Are there specific policies to address cleaning of vomit or diarrhea?

 Yes  No  Unsure  Refused If there is a requirement for this policy mark here ☐

48. Does the policy include how to clean up vomitus or feces?

 Yes  No  Unsure  Refused

49. Does it include how to disinfect the area?

 Yes  No  Unsure  Refused If No, Unsure, Refused → Go to question 51

50. What type of sanitizer do you use and at what concentration for disinfecting these incidents?

    Sanitizer	Mark X if used	Concentration (insert PPM)
    Chlorine, bleach
    Quaternary ammonia
    Iodine
    Other:

51. Do employees use any personal protective equipment while cleaning these incidents?

 Yes  No  Unsure  Refused If No, Unsure, Refused → Go to question 53

52. What type of equipment is provided?

☐ Face mask ☐ Respirator ☐ Single-use gloves ☐ Disposable apron ☐ Shoe covers ☐ Disposable coveralls ☐ Other: _____________________________________ ☐ Unsure ☐ Refused

53. What do you do to food that may have been potentially exposed?

☐ Discard ☐ Cover the food ☐ Other:_______________________________________ ☐ Unsure ☐ Refused

54. What do you do with the plates or other utensils that may have been exposed:

☐ Rewash ☐ Leave alone ☐ Other:___________________________________☐ Unsure ☐ Refused

55. To the best of your knowledge has this restaurant ever had an incident of vomiting or diarrhea that required cleaning?

 Yes  No  Unsure  Refused

Thank you for your time and participation. The results of this survey will be combined with results from other surveys to provide an overall picture of how restaurants are handling ill employees.

Site: _______________________

Establishment Code Number: ________________________

Visit #: ______

Initial Intervention Restaurant: Y N (Circle one)

Additional Notes: