Does a food handler with a mild headache or general fatigue have a reporting duty?

No. The reporting duty is triggered by the five specific symptoms (vomiting, diarrhea, jaundice, sore throat with fever, infected open wound or lesion with pus) and the six specific diagnoses. General feeling-unwell symptoms not on the list do not trigger the duty. Many operations encourage reporting of any illness, but the legal duty is limited to the listed conditions.

What happens if a food handler reports a symptom and the PIC ignores it?

The PIC has violated FDA Food Code §2-201.12 and is subject to citation. The food establishment faces enforcement risk including license action depending on jurisdiction. If a foodborne illness outbreak subsequently traces to the establishment, civil liability exposure can be substantial. The reporting framework only works if the PIC takes appropriate action; failure to act is both a regulatory and civil-liability problem.

Can a food handler with diarrhea work in a non-food-handling role?

No. Diarrhea is an exclusion-tier symptom, not a restriction-tier symptom. The food handler must be excluded entirely from the establishment until symptoms resolve and the return-to-work criteria are met. Restriction to non-food roles is not an available response for diarrhea or vomiting.

How long must a food handler with vomiting or diarrhea wait before returning to work?

Under many Food Code-based rules, vomiting or diarrhea exclusions may be lifted after the employee has been symptom-free for at least 24 hours without medication. Many jurisdictions and Norovirus-specific policies require 48 or 72 hours, and some require medical or regulatory clearance. The food handler must be able to return without active symptoms and without using anti-diarrheal or anti-emetic medication that might mask continued symptoms. The PIC should check the local jurisdiction's rule before authorizing return to work.

Does the reporting duty apply to volunteers or temporary staff?

Yes. The FDA Food Code applies the reporting duty to anyone who works as a food handler in the establishment, including volunteers at a charitable food operation, temporary staff during peak service, and similar. The Conditional Employee Reporting Agreement should be signed by all such individuals before they begin food-handling duties, even for short-term engagements.

What is the difference between the 2009 and 2022 versions of the Big Six list?

The 2009 Food Code listed five pathogens commonly called the "Big Five" (Norovirus, Hepatitis A, Salmonella Typhi, Shigella, STEC). The 2022 Food Code added nontyphoidal Salmonella as the sixth pathogen, making the list the "Big Six." Older training materials may still reference the five-pathogen list; current ServSafe and exam content reflects the 2022 update.

Reporting Illness: When a Food Handler Must Not Work (FDA Big Six + Symptoms)

TL;DR

FDA Food Code 2022 §2-201 requires food handlers to report specified symptoms and diagnoses to the Person in Charge (PIC), who must then exclude or restrict the food handler from food-handling duties depending on the severity. The framework lists five reportable symptoms — vomiting, diarrhea, jaundice, sore throat with fever, and infected open wounds or lesions with pus — and six reportable diagnoses (the "Big Six" pathogens): Norovirus, Hepatitis A, Salmonella Typhi, Shigella, Shiga toxin-producing E. coli (STEC), and non-typhoidal Salmonella (added in the 2022 update). The reporting duty runs from the food handler to the PIC; the exclusion or restriction duty runs from the PIC to the food handler. The framework is the operational complement to the Big Six foodborne illness framework — knowing the pathogens is half the picture; the other half is what to do when you have one.

The food handler's reporting duty

FDA Food Code §2-201.11(A) imposes an affirmative reporting duty on every food handler in a regulated food establishment. The food handler must report to the Person in Charge any of the listed symptoms or diagnoses immediately on becoming aware of them — typically before reporting for the shift or as soon as symptoms develop during a shift. The reporting duty exists regardless of whether the food handler thinks the condition is significant; the PIC, not the food handler, determines the operational response.

The reporting requirement is captured in the Conditional Employee and Food Employee Reporting Agreement (FDA Form 1-B or equivalent). New hires sign the agreement at the start of employment, acknowledging the reporting duty and listing the specific reportable conditions. The signed agreement protects both the food handler (clear understanding of the duty) and the operation (documentation that the duty was communicated). Many state and local jurisdictions require the Conditional Employee Reporting Agreement to be in place before food-handler duties begin.

The 5 reportable symptoms

Five symptoms trigger the reporting and exclusion framework regardless of whether a specific diagnosis has been made:

Vomiting — actively vomiting or recent history of vomiting, even if the food handler feels otherwise well.
Diarrhea — symptomatic, including watery stools or increased stool frequency beyond the food handler's baseline.
Jaundice — yellowing of the skin or eyes, a possible sign of Hepatitis A infection.
Sore throat with fever — both symptoms together, not either alone (a sore throat without fever is not reportable; fever without sore throat may indicate other illness).
Infected wound or lesion with pus — uncovered or improperly covered open wounds on hands, wrists, or arms that contain pus, suggesting potential bacterial contamination.

Each symptom triggers the food handler's reporting duty and the PIC's responsive action under §2-201.12. The symptom-based exclusions are the more common operational scenario — food handlers experience symptoms much more frequently than they receive a specific Big Six diagnosis.

The 6 reportable diagnoses — the "Big Six"

FDA Food Code §2-201.11(A)(2) identifies six pathogens whose diagnosis triggers mandatory exclusion. The list was updated in the 2022 Food Code to include non-typhoidal Salmonella, bringing the total to six pathogens commonly referred to as the "Big Six":

Norovirus — the most common foodborne illness in the United States; highly contagious and a common cause of restaurant outbreaks.
Hepatitis A virus — fecal-oral transmission; vaccine-preventable but still circulates in unvaccinated populations.
Salmonella Typhi — the typhoid fever pathogen; rare in the United States but devastating when it appears.
Shigella spp. — bacterial dysentery; highly contagious through fecal-oral routes.
Shiga toxin-producing E. coli (STEC), including E. coli O157:H7 — produces severe and sometimes fatal illness, particularly in children and elderly.
Nontyphoidal Salmonella — added in the 2022 Food Code update; the most common Salmonella infections in the US.

These diagnoses always trigger the food handler's reporting duty and a required PIC response, but the required action depends on the pathogen, the food handler's symptoms, and whether the establishment serves a highly susceptible population. Symptomatic diagnosed employees are generally excluded from the establishment entirely; some asymptomatic diagnosed employees may be restricted in general-population establishments and excluded in highly susceptible population settings. Hepatitis A and Norovirus have particularly strict response rules. The PIC consults the Food Code framework and may also consult the FDA Employee Health Policy Tool to determine the correct response for the specific pathogen, symptom, and establishment combination.

Exclusion vs. restriction — different responses

FDA Food Code §2-201.12 distinguishes between two PIC responses. Exclusion means the food handler is removed from the establishment entirely — no work in any capacity at the food-service operation. Exclusion is generally required for vomiting or diarrhea (the most communicable symptoms) and for many diagnosis/symptom combinations. For asymptomatic diagnosed employees in general-population establishments, the Food Code response can be either restriction or exclusion depending on the specific pathogen; highly susceptible population settings generally require exclusion in those cases. Restriction means the food handler may work in non-food-handling capacities (host/hostess, cashier, drive-through window with no direct food contact) but cannot prepare, serve, or handle exposed food or food-contact surfaces. Restriction is the PIC's response to sore throat with fever, infected wound/lesion with pus (depending on coverage), or jaundice during diagnostic evaluation.

The exclusion-vs-restriction distinction matters operationally because excluded employees lose all work hours while restricted employees can continue earning in modified roles. Some operations resist the exclusion requirement because of staffing pressure; the FDA Food Code is clear that required exclusion or restriction decisions apply regardless of staffing impact.

Highly susceptible populations — stricter rules

Food establishments serving "highly susceptible populations" (HSP) — defined to include young children, elderly, immunocompromised, and others in healthcare and similar settings — face stricter exclusion and restriction rules. Some symptoms and diagnoses that produce only restriction in general food service produce mandatory exclusion in HSP settings. Operations serving HSPs include hospitals, nursing homes, assisted living facilities, kid-care facilities, and similar.

HSP rules are documented in §2-201.13 and other Food Code provisions. The framework recognizes that the same pathogens that produce mild illness in healthy adults can be life-threatening for vulnerable populations. Cross-reference to personal hygiene practices for food handlers matters because the HSP framework requires stricter personal-hygiene practices generally, not just during illness.

Return-to-work criteria

Excluded and restricted food handlers may return to normal duties only when specific criteria are met under §2-201.13. Symptom-based exclusions (vomiting, diarrhea) typically resolve when symptoms have ceased for 24 hours and the food handler has no fever; some jurisdictions require longer symptom-free periods. Diagnosis-based exclusions resolve only when documented criteria are met — typically clinical resolution, sometimes documented negative stool culture, and a defined waiting period after symptom resolution. Hepatitis A requires medical clearance because the infectious period extends beyond symptom resolution.

The food handler typically must obtain medical clearance documenting return-to-work eligibility for the diagnosis-based exclusions. The PIC retains the medical clearance documentation in the employee's file. Some jurisdictions require notification to the local health department for confirmed Big Six diagnoses before return to work; others require notification at diagnosis with later confirmation of clearance.

The PIC's documentation duty

The Person in Charge bears documentation responsibility for exclusion and restriction decisions. Records must include the food handler's name, the reported symptom or diagnosis, the date of report, the PIC's response (exclusion vs. restriction), and the return-to-work clearance date. Documentation is essential during health department investigations of suspected foodborne illness outbreaks — investigators routinely request employee illness records as part of outbreak source tracing.

Norovirus outbreak response in particular involves intensive documentation — see our food handler norovirus outbreak response guide for the operational protocol when an outbreak is suspected or confirmed. The illness reporting and exclusion framework feeds directly into outbreak response: a properly-documented exclusion of a symptomatic food handler may prevent an outbreak that would otherwise occur, or may demonstrate that the establishment was not the source of an outbreak occurring elsewhere.

Frequently Asked Questions

Does a food handler with a mild headache or general fatigue have a reporting duty?: No. The reporting duty is triggered by the five specific symptoms (vomiting, diarrhea, jaundice, sore throat with fever, infected open wound or lesion with pus) and the six specific diagnoses. General feeling-unwell symptoms not on the list do not trigger the duty. Many operations encourage reporting of any illness, but the legal duty is limited to the listed conditions.
What happens if a food handler reports a symptom and the PIC ignores it?: The PIC has violated FDA Food Code §2-201.12 and is subject to citation. The food establishment faces enforcement risk including license action depending on jurisdiction. If a foodborne illness outbreak subsequently traces to the establishment, civil liability exposure can be substantial. The reporting framework only works if the PIC takes appropriate action; failure to act is both a regulatory and civil-liability problem.
Can a food handler with diarrhea work in a non-food-handling role?: No. Diarrhea is an exclusion-tier symptom, not a restriction-tier symptom. The food handler must be excluded entirely from the establishment until symptoms resolve and the return-to-work criteria are met. Restriction to non-food roles is not an available response for diarrhea or vomiting.
How long must a food handler with vomiting or diarrhea wait before returning to work?: Under many Food Code-based rules, vomiting or diarrhea exclusions may be lifted after the employee has been symptom-free for at least 24 hours without medication. Many jurisdictions and Norovirus-specific policies require 48 or 72 hours, and some require medical or regulatory clearance. The food handler must be able to return without active symptoms and without using anti-diarrheal or anti-emetic medication that might mask continued symptoms. The PIC should check the local jurisdiction's rule before authorizing return to work.
Does the reporting duty apply to volunteers or temporary staff?: Yes. The FDA Food Code applies the reporting duty to anyone who works as a food handler in the establishment, including volunteers at a charitable food operation, temporary staff during peak service, and similar. The Conditional Employee Reporting Agreement should be signed by all such individuals before they begin food-handling duties, even for short-term engagements.
What is the difference between the 2009 and 2022 versions of the Big Six list?: The 2009 Food Code listed five pathogens commonly called the "Big Five" (Norovirus, Hepatitis A, Salmonella Typhi, Shigella, STEC). The 2022 Food Code added nontyphoidal Salmonella as the sixth pathogen, making the list the "Big Six." Older training materials may still reference the five-pathogen list; current ServSafe and exam content reflects the 2022 update.

Bottom Line

FDA Food Code 2022 §2-201 imposes a food-handler reporting duty for five symptoms (vomiting, diarrhea, jaundice, sore throat with fever, infected open wound/lesion with pus) and six diagnoses — the "Big Six" pathogens including the newly-added nontyphoidal Salmonella. The Person in Charge must respond with exclusion or restriction depending on the symptom, diagnosis, pathogen, and whether the establishment serves a highly susceptible population. Vomiting and diarrhea generally require exclusion; some diagnosis-only cases may require restriction in general-population establishments and exclusion in HSP settings. Return-to-work criteria require symptom resolution and, for diagnoses, medical clearance documenting non-infectivity. For the underlying pathogen framework, see our Big Six foodborne illnesses guide. For the full ServSafe exam framework, see our complete ServSafe food handler exam guide.

Source: FDA Food Code 2022 — Full text · FDA Form 1-B — Conditional Employee/Food Employee Reporting Agreement · CDC Food Safety