Attachment 8- Manager Interview
Form Approved
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 or any other aspect of this collection of information, including suggestions for reducing this burden, to: CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0980)
Public reporting burden for this collection of information is estimated to average 20 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 (0920-0980)
OMB No. 0920-0980 Exp. Date 08/31/2019
Part III- Manager interview: Conduct an establishment manager interview after an establishment has been identified for an environmental assessment. This form provides a semi-structured interview; you can probe for more information as needed. Read bold text aloud. Do not read answer choices aloud unless they are bolded. Do not read the Unsure or Refused answer choices.
1a. How long was the interview? Number of minutes: _____________
1b. Date the manager interview was initiated (MM/DD/YYYY): / /
READ ALOUD: I’d like to ask you some questions about this establishment. Please be as open and honest as possible. The first few questions focus on the establishment in general. For these questions, please make your best estimate if you do not know the exact answer.
Is this an independent establishment or a chain establishment?
Independent Unsure
Chain Refused
Approximately how many meals are served here daily? Meals could be estimated using number of customers served or ticket orders. #_____ Unsure Refused
What is the establishment’s busiest day, in terms of number of meals served?
Monday |
Friday |
Unsure |
Tuesday |
Saturday |
Refused |
Wednesday |
Sunday |
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Thursday |
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Are any foods prepared or partially prepared at a commissary or other location?
Yes Unsure
No Refused
Other than daily specials, when was the last time food items were added to your menu(s)?
No changes to menu items have occurred |
More than a month ago |
In the last WEEK |
Unsure |
In the last MONTH |
Refused |
READ ALOUD: The next few questions focus on kitchen managers. As I read the following questions, please keep in mind that we are asking about managers who have control over the kitchen area or back of the house.
Approximately how long have you been employed as a kitchen manager in this establishment?
Length: Unsure Refused
Approximately how long have you worked as a kitchen manager?
Length: Unsure Refused
How many kitchen managers, including you, are currently employed in this establishment? If you aren’t sure, use your best guess.
Number of kitchen managers: ____ Unsure Refused
READ ALOUD: The next few questions focus on the language-related knowledge and skills of all kitchen managers in your establishment. Please think about your language abilities and those of other kitchen managers in this establishment.
For these questions, fluent means able to clearly, easily, and readily understand and communicate verbal messages in the language specified. If a manager is bilingual or trilingual please tell me all languages he or she speaks fluently. For these questions, please make your best estimate if you do not know the exact answer.
What language(s) do you and other managers in this establishment speak fluently? (Check ll that apply)
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What languages do you and other managers speak at work? (Check all that apply)
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In your opinion, how well do you communicate verbally with your food workers: not well at well, somewhat well, or very well?
Not well at all Somewhat well very well
Unsure Refused
READ ALOUD: The next few questions ask about kitchen manager food safety training and certification.
Do any kitchen managers receive food safety training? This training can be a course or a class, or it can be training that occurs on the job.
Yes Unsure Skip to next Read Aloud
No Skip to next read Aloud Refused Skip to next Read Aloud
13a. How many kitchen managers have had food safety training? If you aren’t sure, use your best guess.
Number of managers: _______ Unsure
Refused
13b. What type of food safety training do kitchen managers (you) receive? Is it .. (Check all that apply)
on-the-job training? (Any training conducted by the establishment or corporate office. It might entail posting instructions or material in the establishment, viewing videos, computer-based training taken in the establishment or sending employees to a corporate kitchen for training.)
a class or course taken at a university, community college, culinary school or other educational institution? (Any training conducted by a university, community college, culinary school, health department or similar entity.)
a class or course from an ANSI accredited program that leads to taking an exam? These programs include National Restaurant Association’s ServSafe, National Registry of Food Safety Professionals, Prometric, 360 Training, or AboveTraining/StateFoodSafety.com.
READ ALOUD: The next few questions ask about kitchen manager food safety certification, where you receive a certificate upon completion of the training course.
Does this establishment require that kitchen managers have a food safety certification?
Yes Unsure
No Refused
Are any kitchen managers, including you, food safety certified?
Yes Unsure Skip to next Read Aloud
No Skip to next Read Aloud Refused Skip to next Read Aloud
15a. How many kitchen managers in this establishment, including yourself, are food safety certified by an ANSI accredited program? These include National Restaurant Association’s ServSafe, National Registry of Food Safety Professionals, Prometric, 360 Training, or AboveTraining/ StateFoodSafety.com? If you aren’t sure, use your best guess.
Number of managers: _______ Unsure Refused
15b. How often is a certified kitchen manager present during hours of operation? Is it all of the time, most of the time, some of the time, rarely, or none of the time?
All of the time Most of the time Some of the time Rarely None of the time
READ ALOUD: The next set of questions focuses on food workers, and by food workers I mean employees, excluding managers, who work in the kitchen. This does not include staff who have no food handling responsibilities or who have very limited food contact such as adding garnish or condiments to a plate.
16. How many food workers do you have? If you do not know the exact number, an estimate will be fine.
Number of food workers: _______ If 0, skip to the Read Aloud before #17
Unsure Skip to the Read Aloud before #17 Refused Skip to the Read Aloud before #17
16a. What language(s) do food workers in this establishment speak fluently? (Check all that apply)
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16b.What languages do food workers speak at work? (Check all that apply)
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READ ALOUD: The next few questions focus on food safety training and certification among food workers, excluding managers.
16c.Do any food workers receive food safety training? This training can be a course or a class, or it can be training that occurs on the job.
Yes Unsure Skip to next Read Aloud
No Skip to next Read Aloud Refused Skip to next Read Aloud
16c1. How many food workers have had food safety training? Please make your best estimate if you do not know the exact number.
Number of food workers with training:______ Unsure Refused
16c2. What type of food safety training do food workers receive? Is it… (Check all that apply)
on-the-job training? (Any training conducted by the establishment or corporate office. It might entail posting instructions or material in the establishment, viewing videos, computer-based training taken in the establishment or sending employees to a corporate kitchen for training.)
a class or course taken at a university, community college, culinary school or other educational institution? (Any training conducted by a university, community college, culinary school, health department or similar entity.)
a class or course from an ANSI accredited program that leads to taking an exam? These programs include National Restaurant Association’s ServSafe, National Registry of Food Safety Professionals, Prometric, 360 Training, or AboveTraining/StateFoodSafety.com.
READ ALOUD: Now I’m going to ask you some questions about policies you have in this establishment. Food safety policies can be informal, verbal and part of on-the-job or other establishment training or they may be formal, written documents that state the policy.
17. Does this establishment have a cleaning policy or schedule for
17a. cutting boards? |
Yes No Unsure Refused NA |
17b. food slicers? |
Yes No Unsure Refused NA |
17c. food preparation tables? |
Yes No Unsure Refused NA |
17d. after a worker or customer vomits or has diarrhea in the establishment? |
Yes No Unsure Refused NA |
17e. frequently touched customer surfaces like menus, tables, and condiments? |
Yes No Unsure Refused NA |
If all of the answers to 17a-17e are No, skip to #18.
17f. If they have any of these policies: Are any of these policies written?
Yes Unsure Skip to #18
No Skip to #18 Refused Skip to #18
17f1. Which ones? (Check all that apply)
Cutting boards After vomiting/diarrheal incident
Food slicers Frequently touched customer surfaces
Food preparation tables
18. Does this establishment have a policy for disposable glove use?
Yes Unsure Skip to next Read Aloud
No Skip to next Read Aloud Refused Skip to next Read Aloud
18a. If there is a glove use policy: Does the glove policy require that food workers wear gloves:
18a1. when they have cuts or other injuries? |
Yes No Unsure Refused |
18a2. when handling ready-to-eat foods? |
Yes No Unsure Refused NA |
18a3. when handling raw meat or poultry? |
Yes No Unsure Refused NA |
18a4. at all times while working in the kitchen? |
Yes No Unsure Refused |
18b. If there is a glove use policy: Is the policy written?
Yes Unsure
No Refused
READ ALOUD: The next few questions refer to actual food temperatures, not the ambient temperatures where food is stored. The questions refer to temperatures taken using some type of thermometer.
19. Does this establishment have a policy to take the temperature of any incoming food products?
Yes Unsure
No Refused
20. Excluding incoming products, does this establishment have a policy to take food temperatures?
Yes Unsure
No Refused
READ ALOUD: Now I’d like to ask you a few questions about worker health policies. Again, I am asking about policies that apply to staff who primarily work with food—not staff who have no or very limited food handling responsibilities.
21. When food workers say they are ill, do you typically ask if they are experiencing certain symptoms?
Yes Unsure
No Refused
22. Does this establishment have a policy or procedure that requires food workers to tell a manager when they are ill?
Yes Unsure Skip to #23
No Skip to #23 Refused Skip to #23
22a. Is this policy in writing?
Yes Unsure
No Refused
22b. Does this policy require ill workers to tell managers what their symptoms are?
Yes Unsure
No Refused
22c. Does this policy specify certain symptoms that ill workers are required to tell managers about?
Yes Unsure Skip to #23
No Skip to #23 Refused Skip to #23
22c1. What are those symptoms? (Check all that apply)
Vomiting |
Sore throat with fever |
Diarrhea |
A lesion containing pus (for ex., boil or infected wound) |
Jaundice (yellow eyes or skin) |
Other (Please describe):_____________________________ |
23. Does this establishment have a policy or procedure to restrict or exclude ill workers from working? By restrict I mean the worker can work, but is not allowed to handle food, and by exclude I mean the worker does not work at all.
Yes Unsure Skip to next Read Aloud
No Skip to next Read Aloud Refused Skip to next Read Aloud
23a. Is this policy in writing?
Yes Unsure
No Refused
23b. Does this policy specify the specific symptoms that would prompt excluding or restricting ill workers from working?
Yes Unsure Skip to next Read Aloud
No Skip to next Read Aloud Refused Skip to next Read Aloud
23b1. What are those symptoms? (Check all that apply)
Vomiting |
Sore throat with fever |
Diarrhea |
A lesion containing pus (for ex., boil or infected wound) |
Jaundice (yellow eyes or skin) |
Other (Please describe)_____________________________ |
READ ALOUD: The next few questions focus on the food worker and manager sick leave policy. As I read the following questions please keep in mind that we are asking about managers who have control over the kitchen area or back of the house and food workers that work in the kitchen.
24. Do any kitchen managers (including you) ever get paid when they miss work because they are ill?
Yes Unsure Skip to #25
No Skip to #25 Refused Skip to #25
24a. How many kitchen managers get paid when they miss work because they are ill? Please make your best estimate if you do not know the exact number.
Number of managers::______ Unsure
Refused
25. Do any food workers ever get paid when work is missed because they are ill?
Yes Unsure Skip to #26
No Skip to #29 Refused Skip to #26
25a. How many food workers get paid when they miss work because they are ill? Please make your best estimate if you do not know the exact number.
Number of workers:______ Unsure
Refused
26. Have any practices or policies changed since you were first notified about a potential problem in your restaurant?
Yes Unsure End interview Not applicable End interview
No End interview Refused End interview
26a. What were those changes?
READ ALOUD: Thank you very much.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Modified | 0000-00-00 |
File Created | 0000-00-00 |