Form Approved
OMB No. 0920-0792
Exp. Date 09/30/2018
Attachment 8- EHS-Net Food Worker Recruiting Screener, Consent and Interview
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 CDC/ATSDR
Information Collection Review Office, MS D-74; 1600 Clifton Road NE,
Atlanta, Ga. 30333; ATTN: PRA (0920-0792)
Let me give you a little background on why I’m here. I’m working with __________________ (health department) and Centers for Disease Control and Prevention (CDC) on a research project. Your restaurant was picked at random to be in this project, and your manager said that it would be okay for you to talk to me for a few minutes. However, your participation is voluntary—you don’t have to talk to me if you don’t want to- I won’t tell your manager. If you do talk with me, I won’t tell your manager anything that you say.
Would you be willing to talk to me for about 17 minutes about your work behavior and this restaurant’s policies and practices?
No Okay, thanks for your time. (End interview)
Yes Great, thanks.
I’m going to ask you some questions, and if any of the questions make you uncomfortable you can choose not to answer them. The information we collect today 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 food safety knowledge level and attitudes of food workers, we ask you to be as open and honest as possible.
Do you have any questions?
If you have any questions at a later time, you can contact: (Local Contact Name). (If have card) My information is on this card.
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 4a) No (go to 5) Unsure (go to 5) Refused (go to 5)
4a. Who conducted that training? (Check all that apply)
Management Other (describe) _________________________________
Owner Unsure
Supervisor Refused
Co-worker
4b. Did the training include any of the following?
1…Classroom training Yes No Unsure Refused
2…On-the-job training in the restaurant Yes No Unsure Refused
3…Online training Yes No Unsure Refused
4…A manual or employee handbook Yes No Unsure Refused
5…other kinds of written materials Yes No Unsure Refused
6…Videos or DVDs Yes No Unsure Refused
4c. Did the food safety training include instruction on:
1. How, when, and where to do a hand wash?
Yes No N/A Unsure Refused
2. How and when to use gloves to prevent contamination of foods?
Yes No N/A Unsure Refused
3. Time and temperature control of potentially hazardous foods (or time/temperature for safety foods)?
¦ Yes ¦ No ¦ N/A ¦ Unsure ¦ Refused
4. How to properly clean and sanitize equipment and food contact surfaces?
Yes No N/A Unsure Refused
5. How to prevent or reduce the risk of cross contaminating food during storage, preparation, holding and service?
Yes No N/A Unsure Refused
6. How to use a thermometer to check food temperatures?
Yes No N/A Unsure Refused
7. Final cook temperatures of potential hazardous foods (or time/temperature for safety foods)?
Yes No N/A Unsure Refused
4d. Did you find the training very useful, somewhat useful, not very useful, or not useful at all? (Show scale)
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 that they 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
7. Does your boss/owner think it’s important that food workers 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 food safety test and been issued a card or certificate?
Yes (go to 8a) No (go to 9) Unsure (go to 9) Refused (go to 9)
8a. 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. It’s okay to dry your hands on your apron after washing them when you are really busy.
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 to an internal 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 should 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 130 degrees Fahrenheit.
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
12. 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
N
That’s the end of the interview. Thank you for your time.
| File Type | application/msword |
| Author | lrg |
| Last Modified By | SYSTEM |
| File Modified | 2018-06-25 |
| File Created | 2018-06-25 |