A food handler should be excluded from work when they have certain symptoms, specific diagnosed infections, or jaundice. Under the FDA Food Code, exclusion means the employee cannot work in any capacity inside the food establishment, not even in roles that don’t involve food. The rules distinguish between full exclusion (banned from the premises as an employee) and restriction (allowed to work but kept away from food, equipment, and utensils). Knowing which situations call for which response is essential for any manager or food handler.
What Exclusion Actually Means
Exclusion is the most serious action a food establishment can take. An excluded employee is not permitted to work in or even enter the establishment as an employee. This covers every area where food is received, prepared, stored, served, or transported. The person can still walk in as a customer, but they cannot clock in.
Restriction is a step below that. A restricted employee can still come to work, but their duties must not involve contact with exposed food, clean equipment, utensils, linens, or unwrapped single-use items. Acceptable tasks for a restricted worker include running the cash register, seating guests, bussing tables, stocking canned or packaged goods, or handling non-food maintenance work.
Symptoms That Require Exclusion
Any food handler experiencing vomiting or diarrhea should be excluded immediately. These are the two symptoms that trigger the highest level of concern because they spread pathogens quickly in a food environment. The employee must stay away from work for at least 48 hours after symptoms stop. The CDC specifically recommends this 48-hour symptom-free window for norovirus, and it applies broadly to any unexplained vomiting or diarrhea.
Jaundice, the yellowing of the skin and eyes, also triggers exclusion. If the onset of jaundice occurred within the past seven days, the food handler must be excluded and the situation must be reported to your local regulatory authority. The concern is hepatitis A, which spreads through contaminated food with devastating efficiency. The employee cannot return without written medical documentation confirming the jaundice is not caused by hepatitis A or another infection that spreads through food, plus approval from the regulatory authority.
The Six Pathogens That Mandate Exclusion
The FDA Food Code identifies six specific pathogens, sometimes called “the Big 6,” that require exclusion and regulatory reporting when a food handler receives a confirmed diagnosis. These organisms are highly infectious and can cause severe illness even in tiny quantities:
- Norovirus: the most common cause of foodborne illness outbreaks
- Hepatitis A: a liver infection spread through contaminated food or close contact
- Salmonella Typhi: the bacterium that causes typhoid fever
- Nontyphoidal Salmonella: a broader group of Salmonella strains
- Shigella: a highly contagious bacterium causing severe diarrhea
- E. coli (STEC): strains that produce dangerous toxins, including the type behind major outbreak headlines
A diagnosis with any of these means the employee is excluded from the establishment entirely. The manager must notify the local health department. Returning to work requires written medical clearance from a healthcare provider, and for some of these infections, the requirements are strict. Employees diagnosed with Shigella, STEC, or nontyphoidal Salmonella need two consecutive negative stool tests before clearance. For typhoid fever and hepatitis A, the provider must confirm the employee is free of infection. A recent supplement to the 2022 FDA Food Code also updated testing rules to accept newer diagnostic methods for Shigella, STEC, and nontyphoidal Salmonella.
Sore Throat and Fever
A sore throat with fever creates a restriction situation in most food establishments. The employee should be kept away from food and food-contact surfaces but can potentially work in a non-food role. However, if the establishment serves a highly susceptible population, such as a hospital, nursing home, daycare, or assisted living facility, the rules become stricter. In those settings, a food handler with a sore throat and fever should be excluded entirely, because the people eating the food are far more vulnerable to serious illness.
Wounds, Cuts, and Skin Infections
Not every injury or skin condition triggers exclusion. Open wounds, cuts, burns, and infected boils on the hands or arms can often be managed by covering them with a waterproof bandage and wearing a single-use glove over the top. This applies to a range of conditions including impetigo, shingles, chickenpox lesions, and even staph or MRSA skin infections, as long as the wound can be properly and completely covered.
For staph or MRSA infections, any open or draining wound elsewhere on the body must be covered with a dry, tight-fitting bandage. The critical question is whether the wound can actually be contained. If it’s draining and cannot be effectively covered, the situation needs to be addressed with the local health department, and exclusion may be necessary. A severe infestation of warts on the hands or wrists should similarly be covered with an impermeable barrier and gloves during any food handling.
When an Employee Has Been Exposed but Isn’t Sick
Exposure alone, without symptoms, still requires action. If a food handler lives with someone diagnosed with one of the Big 6 pathogens, or has been otherwise exposed to a confirmed case, they should be restricted from working with food. During this period, they need to be educated about the symptoms to watch for and reminded to report immediately if anything develops. Proper handwashing and glove use should be reinforced.
Hepatitis A exposure is treated more seriously. An exposed employee should be restricted for 30 days, which reflects the virus’s long incubation period. The exception is if the employee can provide medical documentation showing immunity, either from a previous hepatitis A infection or from vaccination.
Returning to Work After Exclusion
The path back to work depends on the reason for exclusion. For symptom-based exclusions where no specific pathogen was diagnosed, the employee generally needs to be symptom-free for at least 48 hours. If symptoms persist or a diagnosis is made, written medical documentation becomes necessary. The healthcare provider must confirm the symptoms were caused by a noninfectious condition or that the employee is free of infection.
For diagnosed Big 6 infections, the process is more involved. Written clearance from a healthcare provider is always required, and for several of these pathogens, lab confirmation through negative test results is mandatory. The regulatory authority, typically your local or state health department, must also approve the return. For jaundice cases, both a medical release and regulatory approval are needed before the employee can set foot back in the establishment as a worker.
Managers should keep documentation of all exclusions, restrictions, and clearances. The FDA Food Code places responsibility on the person in charge to ensure these protocols are followed, and health inspectors will look for evidence that employee health policies are being enforced consistently.