TL;DR

Norovirus is the most common cause of foodborne illness in the United States and one of six pathogens — the "Big 6" — that the FDA Food Code §2-201.11 requires food employees to report to the Person in Charge. The Big 6 are: norovirus, hepatitis A, Shigella spp., Shiga toxin-producing E. coli (STEC), Salmonella Typhi, and nontyphoidal Salmonella. A food employee with active vomiting or diarrhea must be excluded from the food establishment (sent home, not allowed to work) until symptoms have ceased for at least 24 hours, or longer if required by jurisdiction. The 2022 Food Code §2-501.11 requires every food establishment to have written procedures for cleaning vomit and diarrheal events — verbal training is not enough. Norovirus aerosolizes during vomiting and can spread up to 25 feet from the source, so cleanup procedures include a 25- to 30-foot perimeter, PPE, EPA-registered norovirus-rated disinfectants (regular quaternary ammonium sanitizers are not sufficient), and disposal of all exposed food and porous materials.

Why Norovirus Matters

The CDC identifies norovirus as the leading cause of foodborne illness in the United States — responsible for an estimated 19 to 21 million cases of acute gastroenteritis each year. In a food establishment, a single infected employee can expose many customers in one shift, because the virus is extraordinarily contagious. As few as 18 viral particles are enough to cause infection, and an infected person can shed billions of viral particles in vomit and stool. This is why the FDA Food Code treats norovirus as a top-tier reportable illness with mandatory exclusion of symptomatic employees.

Norovirus is also unusually hardy. It survives on surfaces for days, resists many common sanitizers (particularly quaternary ammonium compounds at routine concentrations), and is not killed by hand sanitizer — only thorough handwashing with soap and water physically removes the virus from the skin. Proper handwashing technique is the single most important behavioral control for norovirus prevention.

The Big 6 Reportable Pathogens

FDA Food Code §2-201.11 requires food employees and conditional employees to report specific illnesses and symptoms to the Person in Charge. The "Big 6" are the six pathogens that trigger mandatory restriction or exclusion of an infected food employee:

An employee diagnosed with any of these six must be reported to the Person in Charge immediately. The PIC's response — exclude, restrict, or educate — depends on which pathogen, whether the employee is symptomatic, and whether the establishment serves a highly susceptible population (HSP — children under 9, elderly in care facilities, immunocompromised individuals).

Exclusion vs. Restriction

The Food Code distinguishes two levels of employee response:

For a food employee with active vomiting or diarrhea, exclusion is required regardless of diagnosis — under §2-201.13, the symptom itself triggers exclusion until the employee has been symptom-free for at least 24 hours, or until a medical practitioner provides written documentation that the employee is free of infection.

Return-to-Work Standards

The 2022 FDA Food Code requires that a food employee excluded due to vomiting or diarrhea remain excluded until either of the following:

For confirmed Big 6 illnesses, return-to-work rules are stricter and depend on the pathogen, symptoms, whether the establishment serves a highly susceptible population, and the local regulatory authority's requirements. The Person in Charge should follow the adopted Food Code and health-department instructions before removing an exclusion or restriction. Some state and local jurisdictions impose stricter return-to-work periods for confirmed norovirus (commonly 48 to 72 hours symptom-free), so a Person in Charge must know the specific requirements of the local regulatory authority.

Written Cleanup Procedures Are Required (§2-501.11)

Since the 2017 Food Code, and continuing in the 2022 edition, every food establishment is required to have written procedures for responding to vomiting and diarrheal events. Verbal training alone does not satisfy §2-501.11. The written procedures must address the specific actions employees take to minimize the spread of contamination and exposure of other employees, consumers, food, and surfaces.

A compliant written cleanup procedure includes:

The Conference for Food Protection has emphasized in its 2016 and 2023 Council recommendations that proper written cleanup procedures are not just a best practice — they are a regulatory requirement under §2-501.11, and Food Code compliance inspections check for the written document on site.

Reporting to the Health Department

A single case of foodborne illness in an employee is not by itself reportable to the local health department in most jurisdictions. However, the Person in Charge must report to the regulatory authority when:

State and local health departments have authority to inspect, restrict service, or close an establishment temporarily during a suspected outbreak. Cooperation with the investigation — providing employee health records, food sources, and customer contact lists — is generally required by local law.

What the Exam Tests

Food handler and ServSafe exam questions on norovirus typically test five things:

FAQ

What are the Big 6 reportable pathogens?
Norovirus, hepatitis A, Shigella spp., Shiga toxin-producing E. coli (STEC), Salmonella Typhi, and nontyphoidal Salmonella. These six are listed in FDA Food Code §2-201.11 as triggering mandatory reporting to the Person in Charge and restriction or exclusion of the affected food employee. Nontyphoidal Salmonella was added in the 2017 Food Code edition, expanding the prior "Big 5."
How long must a food employee be excluded after vomiting or diarrhea?
At least 24 hours symptom-free is the basic Food Code standard for vomiting or diarrhea when there is no confirmed Big 6 diagnosis. If a Big 6 pathogen is confirmed or suspected, the Person in Charge must follow the stricter Food Code and local health-department requirements, which may include medical documentation, regulatory approval, or a longer exclusion/restriction period. Some state and local jurisdictions impose stricter 48- to 72-hour exclusion periods for confirmed norovirus — check your local regulatory authority's adopted Food Code edition.
What's the difference between exclusion and restriction?
Exclusion means the employee may not enter the establishment at all. Restriction means the employee may work, but cannot handle exposed food, clean food-contact surfaces, or touch utensils and items used by consumers. Symptomatic employees with any of the Big 6 are excluded. Asymptomatic employees diagnosed with norovirus, Shigella, STEC, or nontyphoidal Salmonella are restricted (in non-HSP establishments); those diagnosed with hepatitis A or Salmonella Typhi are always excluded.
Why isn't regular sanitizer enough to disinfect a norovirus contamination event?
Many quaternary ammonium sanitizers at routine concentrations are not effective against norovirus. The EPA maintains List G of antimicrobial products with proven efficacy against norovirus. Chlorine bleach at 1,000 to 5,000 ppm (about 1 cup of household bleach per gallon of water) is the most commonly recommended disinfectant. Routine food-contact-surface sanitizer should not be relied on for a vomit or diarrheal event.
How far does norovirus spread when someone vomits?
Studies cited in the FDA Food Code Annex and by the Conference for Food Protection indicate norovirus aerosols can spread up to 25 feet from the source. This is why §2-501.11 written cleanup procedures must establish a containment perimeter of at least 25 feet, remove all customers and exposed food from that area, and disinfect the full perimeter — not just the visible contamination.
Are vomit and diarrhea cleanup procedures required to be written?
Yes. FDA Food Code §2-501.11 (added to the 2017 Code and continued in 2022) requires food establishments to have written procedures for employees to follow when responding to vomiting or diarrheal events. Verbal-only training does not satisfy the requirement, and Food Code compliance inspections check for the written document on site.

Bottom Line

Norovirus is the leading cause of foodborne illness in the United States, and the FDA Food Code treats it as a top-tier reportable pathogen. Know the Big 6 reportable pathogens (norovirus, hepatitis A, Shigella, STEC, Salmonella Typhi, nontyphoidal Salmonella) and that they are listed in §2-201.11. Know that vomiting or diarrhea automatically triggers exclusion until at least 24 hours symptom-free under §2-201.13. Know that the 2022 Food Code §2-501.11 requires written cleanup procedures with a 25-foot containment perimeter and EPA-registered norovirus-rated disinfectants — routine sanitizer is not enough. The reporting chain is employee → Person in Charge → regulatory authority. For the broader Big 6 framework that surrounds norovirus, see our food handler Big 6 foodborne illness guide, and for the surface-control side, see our cleaning vs sanitizing vs disinfecting guide.

Source: FDA Food Code 2022 · FDA — Employee Health and Personal Hygiene Handbook · CDC — Norovirus