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Employee illness and exclusion log

One row per report. Record the decision you made and the basis for letting someone back.

HACCPLAN-EI-01
v1.0
haccplan.com
Facility name
Period
Person in charge
Threshold / authority
Vomiting · diarrhoea · jaundice · sore throat with fever · infected wound — report and act · FDA Food Code §2-201.11 · The Big Six diagnoses are Norovirus, Hepatitis A, Shigella, E. coli (STEC), Salmonella Typhi and non-typhoidal Salmonella. A diagnosis means notifying the health authority.
DateEmployeeSymptom or diagnosis reportedExcluded or restrictedHealth authority told?Return date and basisPerson in charge
Weekly supervisor verification
I have reviewed this log for the period above and confirm that any out-of-range readings have a documented corrective action.
Supervisor signature
Week ending
Date signed
Records retention
The FDA Food Code sets no general retention period for this log. Keep it at least as long as your health department requires — ask them, and never keep less. Treat it as confidential: it holds health information about named people.
Source
HACCPlan · haccplan.com
Free for any operator to use.
How to fill this in Excluded = not on the premises. Restricted = on site but not handling food or clean equipment.