Symptoms Reported or Observed Diagnosed E. coli, Date Health Report Employee of Salmonella, Returned Department Date Name skin) Comments or Additional Symptoms Shigella, to Work Contacted? nose, or Throat Fever Norovirus, (yes or no) Hepatitis A with Diarrhea Vomiting Respiratory eyes Sore Jaundice (yellowing sneezing, coughing) (runny Called out, returned symptom free 01/01/10 John Doe X 01/03/10 NO for 24 hours **Employees with diarrhea or vomiting MUST BE EXCLUDED from work for at LEAST 24 HOURS after symptoms are gone.
Report Date Employee Name Symptoms Reported or Observed Date Returned to Work Diagnosed Vomiting Diarrhea Jaundice (yellowing of eyes or skin) Sore Throat with Fever Respiratory (runny nose, sneezing, coughing) Comments or Additional Symptoms E. coli, Salmonella, Shigella, Norovirus, Hepatitis A Health Department Contacted? (yes or no) 01/01/10 John Doe X Called out, returned symptom free for 24 hours 01/03/10 NO **Employees with diarrhea or vomiting MUST BE EXCLUDED from work for at LEAST 24 HOURS after symptoms are gone.