Report Employee Symptoms Comments/Additional Date Diagnosed? Date Name Symptoms Returned Typhoid Fever, Called local to Work Shigella, Shiga health Toxin agency? In producing Y or N or E.coli, Throat Hepatitis A, Wound Sore Norovirus, Boil w/ Nontyphoidal Salmonella** Vomiting* Diarrhea* Pustular Fever Jaundice Infected compliance with Michigan Food Code 2-201.12/2-201.13. *Employees with Diarrhea and Vomiting MUST BE EXCLUDED from work for AT LEAST 24 HOURS after symptoms are gone. **Employees diagnosed with Typhoid Fever, Shigella, Shiga Toxin producing E.coli, Hepatitis A, Norovirus, or Nontyphoidal Salmonella must be excluded until Health Department clearance.
Report Date Employee Name Symptoms Comments/Additional Symptoms Date Returned to Work Diagnosed? Vomiting* Diarrhea* Jaundice Fever w/ Sore Throat Infected Wound or Pustular Boil Typhoid Fever, Shigella, Shiga Toxin producing E.coli, Hepatitis A, Norovirus, Nontyphoidal Salmonella** Called local health agency? Y or N In compliance with Michigan Food Code 2-201.12/2-201.13. *Employees with Diarrhea and Vomiting MUST BE EXCLUDED from work for AT LEAST 24 HOURS after symptoms are gone. **Employees diagnosed with Typhoid Fever, Shigella, Shiga Toxin producing E.coli, Hepatitis A, Norovirus, or Nontyphoidal Salmonella must be excluded until Health Department clearance.