Staff Return to Work Assessment

Hygienic Food Safety (HFS) Compliance Pillar 03

Full Name of Food Handler

Current Date

PART 1: COMPREHENSIVE SYMPTOM DISCLOSURE

Symptom / Health Condition	Response
Have you suffered from diarrhoea or vomiting in the last 48 hours?
Do you have any infected skin lesions, boils, or septic cuts on your hands or arms?
Have you experienced jaundice (yellowing of eyes/skin) in the last 7 days?
Do you currently have a fever accompanied by a sore throat?
Is there any discharge from your eyes, ears, or nose (secretion)?
Has anyone in your immediate household suffered from typhoid, cholera, or dysentery recently?
Are you currently taking any medication to suppress symptoms of diarrhoea?

MANAGEMENT AUTHORIZATION & DECISION

FIT FOR HIGH-RISK FOOD HANDLING
RESTRICTED TO NON-FOOD DUTIES ONLY
UNFIT FOR DUTY (RE-ASSESS IN 24/48 HOURS)

Manager’s Notes (e.g., Doctors Note sighted, PPE required)

Employee Acknowledgement

Manager Verification

HFS SCIENTIFIC NOTE: Asymptomatic shedding of Norovirus can continue for several days after physical recovery. Failure to exclude staff for the full 48-hour symptom-free period is a primary cause of institutional foodborne illness.

LOG STATUS: PENDING SAVE