Form
Approved OMB
No. 0920-0980 Exp.
Date xx/xx/xxxx
CDC estimates the average public reporting burden for this collection of information as 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: CDC/ATSDR Information Collection Review Office, MS D-74; 1600 Clifton Road NE, Atlanta, Ga. 30333; ATTN: PRA (0920-0980)
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Do not read answer choices aloud unless specifically noted using bold text. Do not read the Unsure or Refused answer choices.
1. Date the manager interview was conducted (MM/DD/YYYY): _____/_____/________
READ ALOUD:
I’d like to ask you some questions about this establishment. Please be as open and honest as possible. The first few questions focus on the establishment in general. Please make your best estimate if you do not know the exact number for the following questions.
2.
Is this an independent establishment or a chain establishment?
Independent
Chain
Unsure
Refused
3. Approximately how many meals are served here daily?
(Give number) ______________
Refused
4.
What is the establishment’s busiest day, in terms of number of
meals served?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Refused
5.
Are any foods prepared or partially prepared at a commissary or other
location?
Yes
No
Unsure
Refused
6.
Other than daily specials, when was the last time food items were
added to your menu(s)?
No
changes to menu items have occurred
In the last WEEK
In the last MONTH
More than a month ago
Unsure
Refused
7. Where does the establishment purchase or acquire its food? (Select all that apply, probe for additional responses.)
General Distributor/Wholesaler
Corporate Distributor
Grocery Store/Supermarket/Warehouse Store
Farmer’s Market
Other Restaurant
Nonregulated Entity
Other (describe) _______________
Unsure
Refused
Kitchen Manager
READ ALOUD:
The next few questions focus on kitchen managers. As I read the following questions, please keep in mind that we are asking about managers who have control over the kitchen area or back of the house.
8. In total how long have you worked as a kitchen manager?
Less than 6 months 6 months-less than a year
1 year – less than 2 years
2 years – less than 4 years
4 years – less than 6 years
6 years – less than 8 years
8 years – less than 10 years
10 or more years
Refused
9. Approximately how long have you been employed as a kitchen manager in this establishment?
Less than 6 months 6 months-less than a year
1 year – less than 2 years
2 years – less than 4 years
4 years – less than 6 years
6 years – less than 8 years
8 years – less than 10 years
10 or more years
Refused
10. How many kitchen managers, including you, are currently employed in this establishment? If you aren’t sure, use your best guess.
Number of managers: ______________
Unsure
Refused
READ ALOUD:
The next few questions focus on the language-related knowledge and skills of all kitchen managers in your establishment. Please think about your language abilities and those of other kitchen managers in this establishment.
For the purpose of these questions, fluent means able to clearly, easily, and readily understand and communicate verbal messages in the language specified.
If a manager is bilingual or trilingual please check all languages he or she speaks fluently.
Please make your best estimate if you do not know the exact number for the following questions.
11. What language(s) do you and other managers in this establishment speak fluently? (Check all that apply)
English
Spanish
French
Chinese (any dialect)
Japanese
Other
12. What languages do you and other managers speak at work? (Check all that apply)
English
Spanish
French
Chinese (any dialect)
Japanese
Other
13. In your opinion, how well do you communicate verbally with your food workers: very well, somewhat well, or not well at all?
Not well at all
Somewhat well
Very well
Unsure/Don’t know
READ ALOUD:
The next few questions ask about kitchen manager food safety training and certification.
14. Do any kitchen managers receive food safety training? This training can be a course or a class, or it can be training that occurs on the job.
Yes
No If No, skip to #15
Unsure If Unsure, skip to #15
Refused If Refused, skip to #15
a. How many kitchen managers have had food safety training? If you aren’t sure, use your best guess.
Number of managers:____________
Unsure
Refused
b. What type of food safety training do kitchen managers (you) receive? Is it on the job or a class or a course taken somewhere other than work, or both of these types? (Check all that apply)
On the job training (any sort of training conducted by the establishment or corporate office. It might entail posting instructions or material in the establishment, viewing videos, computer-based training taken in the establishment or sending employees to a corporate kitchen for training.)
A class/course taken at a university, community college, or culinary school or other educational institution (A class or course refers to any training conducted by a university, community college, culinary school, health department or similar entity.)
READ ALOUD:
The next few questions ask about kitchen manager food safety certification, where you receive a certificate upon completion of the training course.
15. Does this establishment require that kitchen managers have a food safety certification? Yes
No
Unsure
Refused
16. Are any kitchen managers, including you, food safety certified? Yes
No If No, skip to Food Workers Read Aloud
Unsure If Unsure, skip to Food Workers Read Aloud
Refused If Refused, skip to Food Workers Read Aloud
a. How many kitchen managers in this establishment, including yourself, are food safety certified by an ANSI accredited program such as ServSafe National Registry of Food Safety Professionals/Environmental Health Testing or Thomson Prometric? If you aren’t sure, use your best guess.
Number of managers: __________
Unsure
Refused
Food Workers
READ ALOUD:
The next set of questions focuses on food workers, and by food workers I mean employees, excluding managers, who work in the kitchen. This does not include staff who have no food handling responsibilities or who have very limited food contact such as adding garnish or condiments to a plate.
17. How many food workers do you have? If you do not know the exact number, an estimate will be fine.
Number of workers: ___________ If 0, skip to #21
Unsure
Refused
18. What language(s) do food workers in this establishment speak fluently? (Check all that apply)
English
Spanish
French
Chinese (any dialect)
Japanese
Other
19. What languages do food workers speak at work? (Check all that apply)
English
Spanish
French
Chinese (any dialect)
Japanese
Other
READ ALOUD:
The next few questions focus on food safety training and certification among food workers, excluding managers, and food worker sick leave policies.
20. Do any food workers receive food safety training? This training can be a course or a class, or it can be training that occurs on the job.
Yes
No If No, skip to #21
Unsure If Unsure, skip to #21
Refused If Refused, skip to #21
a. How many food workers have had food safety training? Please make your best estimate if you do not know the exact number.
Number of workers: __________
Unsure
Refused
b. What type of food safety training do food workers receive? Is it on the job or a class or course taken somewhere other than work, or both of these types? (Check all that apply)
On the job training (any sort of training conducted by the establishment or corporate office. It might entail posting instructions or material in the establishment, viewing videos, computer-based training taken in the establishment or sending employees to a corporate kitchen for training.)
A class/course taken at a university, community college, or culinary school or other educational institution (A class or course refers to any training conducted by a university, community college, culinary school, health department or similar entity.)
Policy
READ ALOUD:
Now I’m going to ask you some questions about policies you have in this establishment. Food safety policies can be informal and part of on-the-job or other establishment training or they may be formal, written documents that state the policy.
21. Does this establishment have a cleaning policy or schedule for the kitchen floor?
Yes
No If No, skip to #22
Unsure If Unsure, skip to #22
Refused If Refused, skip to #22
a. Is this policy written?
Yes
No
Unsure
Refused
22. Does this establishment have a cleaning policy or schedule for the refrigerator units, such as a walk-in or reach-in?
Yes
No If No, skip to #23
N/A If N/A, skip to #23
Unsure If Unsure, skip to #23
Refused If Refused, skip to #23
a. Is this policy written?
Yes
No
Unsure
Refused
23. Does this establishment have a cleaning policy or schedule for the cutting boards?
Yes
No If No, skip to #24
N/A If N/A, skip to #24
Unsure If Unsure, skip to #24
Refused If Refused, skip to #24
a. Is this policy written?
Yes
No
Unsure
Refused
24. Does this establishment have a cleaning policy or schedule for the food slicers?
Yes
No If No, skip to #25
N/A If N/A, skip to #25
Unsure If Unsure, skip to #25
Refused If Refused, skip to #25
a. Is this policy written?
Yes
No
Unsure
Refused
25. Does this establishment have a cleaning policy or schedule for the food preparation tables?
Yes
No If No, skip to #26
N/A If N/A, skip to #26
Unsure If Unsure, skip to #26
Refused If Refused, skip to #26
a. Is this policy written?
Yes
No
Unsure
Refused
26. Does this establishment have a policy concerning disposable glove use? Yes
No If No, skip to #28
Unsure If Unsure, skip to #28
Refused If Refused, skip to #28
a. Is this policy written?
Yes
No
Unsure
Refused
27. Does the glove policy require that food workers wear gloves:
a. …at all times while working in the kitchen?
Yes If Yes, skip to #28
No
Unsure
Refused
b. …when handling ready-to-eat foods?
Yes
No
Unsure
Refused
c. …when handling raw meat or poultry?
Yes
No
Unsure
N/A
Refused
d. …when they have cuts or other skin injuries?
Yes
No
Unsure
Refused
Food Temperatures
READ ALOUD:
The next few questions refer to actual food temperatures, not the ambient temperatures where food is stored. The questions refer to temperatures taken using some type of thermometer.
28. Does this establishment have a policy to take the temperature of any incoming food products?
Yes
No If No, skip to #29
Unsure If Unsure, #29
Refused If Refused, skip to #29
a. Are temperatures of incoming products recorded?
Yes
No
Unsure
Refused
29. Excluding incoming products, does this establishment have a policy to take food temperatures?
Yes
No If No, skip to Health Policies Read Aloud
Unsure If Unsure, skip to Health Policies Read Aloud
Refused If Refused, skip to Health Policies Read Aloud
a. Are these food temperatures recorded?
Yes
No
Unsure
Refused
Health Policies
READ ALOUD:
Now I’d like to ask you a few questions about worker health policies. Again, I am asking about policies that apply to staff who primarily work with food—not staff who have no or very limited food handling responsibilities.
30. Does this establishment have a policy or procedure that requires food workers to tell a manager when they are ill?
Yes
No If No, skip to #31
Unsure If Unsure, skip to #31
Refused If Refused, skip to #31
a. Is this policy in writing? Yes
No
Unsure
Refused
b. Does this policy require ill workers to tell managers what their symptoms are? Yes
No
Unsure
Refused
c. Does this policy specify certain symptoms that ill workers are required to tell managers about? Yes
No If No, skip to #30d
Unsure If Unsure, skip to #30d
Refused If Refused, skip to #30d
c1. What are those symptoms? (Check all that apply)
Vomiting
Diarrhea
Jaundice (yellow eyes or skin)
Sore throat with fever
A lesion containing pus (for example, boil or infected wound that is open or draining)
Other (Please describe) ____________________________________
d. Does this policy apply to kitchen managers as well as food workers? For example, are kitchen managers required to tell their managers or owners when they are ill? Yes
No
Unsure
Refused
31. When food workers say they are ill, do you typically ask if they are experiencing certain symptoms?
Yes
No If No, skip to #32
Unsure If Unsure, skip to #32
Refused If Refused, skip to #32
a. What are those symptoms? (Check all that apply)
Vomiting
Jaundice (yellow eyes or skin)
Diarrhea
Sore throat with fever
A lesion containing pus (for example, boil or infected wound that is open or draining)
Other (Please describe) ____________________________________
32. Does this establishment have a policy or procedure to restrict or exclude ill workers from working? By restrict I mean the worker can work, but is not allowed to handle food, and by exclude I mean the worker does not work at all.
Yes
No If No, skip to #33
Unsure If Unsure, skip to #33
Refused If Refused, skip to #33
a. Is this policy in writing? Yes
No
Unsure
Refused
b. Does this policy specify the specific symptoms that would prompt excluding or restricting ill workers from working? Yes
No If No, skip to #32c
Unsure If Unsure, skip to #32c
Refused If Refused, skip to #32c
b1. What are those symptoms? (Check all that apply)
Vomiting
Diarrhea
Jaundice (yellow eyes or skin)
Sore throat with fever
A lesion containing pus (for example, boil or infected wound that is open or draining)
Other (Please describe) ____________________________________
c. Does this policy apply to kitchen managers as well as food workers? For example, are ill kitchen managers excluded or restricted from working? Yes
No
Unsure
Refused
READ ALOUD:
The next few questions focus on the food worker and manager sick leave policy. As I read the following questions please keep in mind that we are asking about managers who have control over the kitchen area or back of the house and food workers who are employees that work in the kitchen.
33. Do any kitchen managers (you) ever get paid when they miss work because they are ill? Yes
No If No, skip to #34
Unsure If Unsure, skip to #34
Refused If Refused, skip to #34
a. How many kitchen managers get paid when they miss work because they are ill? Please make your best estimate if you do not know the exact number. Number of kitchen managers: ______________
Unsure
Refused
34. Do any food workers ever get paid when work is missed because they are ill? Yes
No If No, skip to End of Manager Interview
Unsure If Unsure, skip to End of Manager Interview
Refused If Refused, skip to End of Manager Interview
a. How many food workers get paid when they miss work because they are ill? Please make your best estimate if you do not know the exact number. Number of food workers: ______________
Unsure
Refused
READ ALOUD:
Thank you very much.
End of Manager Interview
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Coleman, Erik W. (CDC/ONDIEH/NCEH) |
File Modified | 0000-00-00 |
File Created | 2021-01-24 |