Form Approved
OMB No. 0920-0792
Exp. Date 08/31/2021
Attachment 4- Example of EHS-Net Manager Interview
_______________________________________________________________________________
Public reporting burden for
this collection of information is estimated to average 30 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
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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)
DEMOGRAPHIC / CLASSIFICATION
I’d
like to ask you some questions about this restaurant. Please be as
open and honest as possible. The first few questions are general
questions about the restaurant.
Is this an independent establishment or a chain establishment?
Independent Chain Unsure Refused
Approximately how many meals are served here on your busiest day?_______ Unsure Refused
Which one of the options below best describes the menu for this establishment- American, Asian, Mexican, Italian, or Other?
American (non-ethnic) Asian Mexican Italian Other Unsure Refused
4. Approximately how long have you been employed as the Person-In-Charge- the PIC- or kitchen manager here? _______ Unsure Refused
MANAGER FOOD SAFETY TRAINING AND CERTIFICATION
The next few questions are about kitchen managers- managers that have control over the kitchen area.
5. How many PICs/kitchen managers, including you, work in this restaurant? ________
Unsure Refused
6. Have you received food safety training on topics such as how to do a proper hand wash, final cook temperatures or ways to prevent cross contamination? This training could have occurred on the job, or in a course or class.
Yes No Unsure Refused
7. Have other PICs or kitchen managers received food safety training?
Yes (go to 7a) No (go to 8) Unsure (go to 8) Refused (go to 8)
7a. How many other managers have had this food safety training?_____
Unsure Refused
8. Have you, as the PIC or kitchen manager, ever been food safety certified? By food safety 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, this program may or may not have involved training.
Yes (go to 8a) No (go to 9) Unsure (go to 9) Refused (go to 9)
8a. Do you currently hold a valid food safety manager certificate?
Yes (go to 8b) No (go to 9) Unsure (go to 9) Refused (go to 9)
8b. What organization provided the certificate- 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 (known formerly as: Experior Assessments, National Assessment Institute, Chauncy, Educational Testing Service)
A state or local health department
Other, describe: _________________________________________________
Unsure
Refused
8c. Was training provided before the exam?
Yes (go to 8d) (go to 8d) Unsure (go to 9) Refused (go to 9)
8d. Did the training include any of the following?
1…Classroom training Yes No Unsure Refused
2…On-the-job training 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
8e. Is food safety training a required part of the certification program?
Yes (go to 8f) No (go to 9) Unsure (go to 9) Refused (go to 9)
9. Have any other PICs or kitchen managers on staff here been food safety certified?
Yes (go to 9a) No (go to 10) Unsure (go to 10) Refused (go to 10)
9a. How many PICs or kitchen managers are food safety certified?________ Unsure Refused
9b. What organization provided their 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:___________________________________________
10. Does this establishment require PICs or kitchen managers to be food safety certified?
Yes No Unsure Refused
FOOD WORKER FOOD SAFETY TRAINING AND CERTIFICATION
The next few questions focus on food workers- 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.
11. How many food workers, excluding managers, work in this restaurant?________ Unsure Refused
12. Have any food workers received training focused on food safety, training that might include topics such as how to do a proper hand wash, when and where to wash, or ways to prevent cross contamination? The training may occur on the job, or in a course or a class.
Yes (go to 12a) No (go to 13) Unsure (go to 13) Refused (go to 13)
12a. How many food workers have received this food safety training? ________ Unsure Refused
12b. Does the food safety training provide 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 food?
Yes No N/A Unsure Refused
3. Time and temperature control of potentially hazardous 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?
Yes No N/A Unsure Refused
12c. Does 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
13. Have any food workers been food safety certified? By food safety certified, I mean they have taken a test written by a national testing organization and been issued a card with an expiration date on it.
Yes (go to 13a) No (go to 14) Unsure (go to 14) Refused (go to 14)
13a. How many food workers have been food safety certified?________ Unsure Refused
13b. 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
FOOD HANDLING PRACTICES AND POLICIES
Now I’d like to ask you some general questions about this establishment’s food handling practices and policies. If the question refers to something your restaurant doesn’t cook or do, just let me know.
14. Does this establishment have a policy or procedure concerning hand washing? This policy may include information such as where or when food workers should wash.
Yes (go to 14a) No (go to 15) Unsure (go to 15) Refused (go to 15)
14a. Is the policy written?
Yes No Unsure Refused
15. Does this establishment have a policy that requires food workers to minimize bare hand contact with ready-to-eat foods, such as salads, by using gloves, utensils or deli tissues?
Yes (go to 15a) No (go to 16) Unsure (go to 16) Refused (go to 16)
15a. Is the policy written?
Yes No Unsure Refused
Does this restaurant cook raw animal products such as ground beef, chicken, fish, or eggs?
Yes (go to 16a) No (go to 17) Unsure (go to 17) Refused (go to 17)
16a. Does this restaurant have a policy that specifies the final cook temperatures for these raw animal products?
Yes (go to 16b) No (go to 17) Unsure (go to 17) Refused (go to 17)
16b. Is the policy written?
Yes No Unsure Refused
16c. What does the policy state the final cook temperature is for menu items containing ground beef?
______F
No ground beef served The policy does not address ground beef
Unsure Refused
16d. How do food workers determine the final cook temperature of raw animal foods such as ground beef, chicken, or eggs? (Check all that apply)
By using a thermometer (go to 16d1) They just know (go to 17)
By its appearance (“eye-ball” it) (go to 17) Other, Describe:___________ (go to 17)
By touch or probing with a fork/utensil (go to 17) Unsure (go to 17)
By using a timer (go to 17) Refused (go to 17)
16d1. Are food workers trained to check the accuracy of these instruments?
Yes No Unsure Refused
Does this restaurant ever hold hot foods?
Yes No Unsure Refused
17a.Does this restaurant have a policy that specifies the temperature at which potentially hazardous foods should be hot held?
Yes (go to17a1) No (go to18) Unsure (go to 18) Refused (go to 18)
17a1. What is that temperature? _______F N/A Unsure Refused
17a2. Is the policy written?
Yes No Unsure Refused
Does this restaurant have a policy that specifies the temperature at which potentially hazardous foods should be cold held?
Yes (go to18a) No (go to19) Unsure (go to 19) Refused (go to 19)
18a. What is that temperature? _______F N/A Unsure Refused
18b. Is the policy written?
Yes No Unsure Refused
19. How do food workers determine the temperature of hot or cold held food? (Check all that apply)
By using a thermometer (go to 19a) They just know (go to 20)
By its appearance (“eye-ball” it) (go to 20) Other, Describe:___________ (go to 20)
By touch or probing with a fork/utensil (go to20) Unsure (go to 20)
By using a timer (go to 20) Refused (go to 20)
19a. Are food workers trained to check the accuracy of these instruments?
Yes No Unsure Refused
20. Does this restaurant have a policy on how to store in-use wet wiping cloths?
No in-use wet wiping cloths are stored (go to 21)
Yes (go to 20a) No (go to 21) Unsure (go to 21) Refused (go to 21)
20a. If yes, does the policy include use of a sanitizing solution?
Yes No Unsure Refused
20b. Is the policy written?
Yes No Unsure Refused
21. Does this establishment have a policy on how to set up manual dish washing using a three-bay sink?
No manual dishwasher in 3-bay sink (go to 22) No 3-bay sink (go to 22)
Yes (go to 21a) No (go to 22) Unsure (go to 22) Refused (go to 22)
21a. Does the policy include steps on how to measure the concentration of the sanitizing solution?
Yes No Unsure Refused
21b. Is the policy written?
Yes No Unsure Refused
22. Does this restaurant have a policy that addresses employee health?
Yes (go to 22a) No (go to 23) Unsure (go to 23) Refused (go to 23)
22a. Is the policy written?
Yes No Unsure Refused
Now I am going to ask you a series of questions about your beliefs, your food workers’ beliefs, and your boss’s beliefs. I going to read a series of things, and I’d like to tell me how important you think it is for food workers to do those things. You can say very important, somewhat important, or not really important. So how important do you think it is that food workers properly sanitize equipment and utensils?
Repeat for all actions; repeat for food workers and the boss.
On a scale of… (Show scale) Very Important, Somewhat Important, and Not Really Important… |
23. How important do YOU think it is that Food Workers… |
24. How important do your FOOD WORKERS think it is that they… |
25. How important does YOUR BOSS think it is that Food workers… |
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VI SI NRI N/A |
VI SI NRI N/A |
VI SI NRI N/A |
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m m m m |
m m m m |
m m m m |
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m m m m |
m m m m |
m m m m |
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m m m m |
m m m m |
m m m m |
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m m m m |
m m m m |
m m m m |
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m m m m |
m m m m |
m m m m |
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m m m m |
m m m m |
m m m m |
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m m m m |
m m m m |
m m m m |
Thanks. Now, just a few more questions about how you see the overall food safety situation here. I’d like you to answer the next questions by choosing a response from this scale – ‘Yes, definitely’ to ‘No, not at all’.” Please listen to each question, and choose your answer from one of these here on the scale. Show scale. Ask each question, and check their response.
m Yes, definitely m Yes, sort of m Not sure m No, not really m No, not at all m Refused
m Yes, definitely m Yes, sort of m Not sure m No, not really m No, not at all m Refused
Do you feel that you have been given enough authority/ position by your Boss or Owner to be able to effectively manage food safety in this establishment?
m Yes, definitely m Yes, sort of m Not sure m No, not really m No, not at all m Refused
29. What is the highest level of formal education you have completed?
8th grade or less m College degree
Some high school m Some graduate work
High school diploma m Graduate degree
Some community college or associate work m Other (describe) ____________
Community college or associate degree m Unsure
Some college m Refused
30. 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
31. 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:
Male m Female m Unsure
Thank you, that’s the end of the interview section. Now I would like you to take this short quiz, it’s 11 questions and shouldn’t take you very long to complete.
Pink eye
Runny nose and sneezing
Vomiting and diarrhea
All of the above
2. Raw hamburger patties should be cooked to an internal temperature of
135°F (57°C).
140°F (60°C).
150°F (66°C).
155°F (68°C).
3. What should you do to ensure that the sanitizing solution you are using on a food preparation surface will work properly?
When mixing the solution, use a test kit to check its concentration.
When using the solution, rinse it from the surface and then let it air dry.
After using the solution, test the surface to confirm that no more microorganisms are present.
D. None of the above.
Wet hands with warm water. Apply soap. Vigorously scrub hands and arms for 10-15 seconds. Rinse hands. Dry hands.
B. Wet hands with warm water. Apply soap. Vigorously scrub hands and arms for 2-5 seconds. Apply a hand antiseptic. Dry hands.
C. Wet hands with warm water. Apply soap. Rinse hands. Dry hands.
D. None of the above.
O°F (-17°C)
32°F (0°C)
41°F (5°C)
60°F (16°C)
When they become soiled or torn
After taking out the trash
After handling raw meat and before handling ready-to-eat foods
All of the above
115°F (46°C)
125°F (52°C)
135°F (57°C)
155°F (68°C)
8. What is the correct way to clean and sanitize a prep table?
Rinse, wash, sanitize
Wash, rinse, sanitize
Sanitize, wash, rinse
Rinse, sanitize, wash
A. 165° F (74°C)
B. 150° F (66°C)
C. 145° F (63°C)
D. 155° F (68°C)
10. Food handlers must wash their hands before they start work and after:
A. Using the restroom.
B. Sneezing, coughing, or using a tissue.
C. Handling raw meat, poultry, or seafood.
D. All of the above.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Time evaluation began: _____:_____ AM PM |
| Author | lrg |
| File Modified | 0000-00-00 |
| File Created | 2021-08-17 |