Preview Health Guard Restaurant

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F o o d

S a f e t y

Developed by the NSF Center for Public Health Education

ProfessionalFood ManagerCertification

Training Version 4.0

Center for

Public Health Education



© 2006 - NSF International

Table of Contents

Chapter 1 – Introduction to Food Safety . . . . . . . . . . . . . . . . . . . .1

1.1 Introduction to Foodborne Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . .21.1.1 People at Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

1.1.2 Potentially Hazardous Foods (Time Temperaature Control for SafetyFood) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

1.1.3 Five Risk Factors for Foodborne Illness . . . . . . . . . . . . . . . . . . . . .5

1.1.4 How to Ensure Food Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

1.2 Rights and Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

1.2.1 Consumer Rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

1.2.2 Management Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . .7

1.2.3 Person in Charge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Chapter 2 – Hazards and Sources of Contamination . . . . . . . . . .19

2.1 Food Safety Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

2.2 Physical Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

2.3 Chemical Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

2.3.1 Food Allergies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

2.4 Biological Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

2.4.1 Intoxication vs. Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .242.4.2 Bacteria and FAT TOM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24

2.4.3 Viruses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

2.4.4 Parasites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

2.4.5 Fungi, Molds and Yeasts . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

2.4.6 Biological Toxins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29

Chapter 3 – Employee Health and Personal Hygiene . . . . . . . . . .41

3.1 Employee Health and Hygiene . . . . . . . . . . . . . . . . . . . . . . . . . . . .42

3.2 Diseases Not Spread Through Food . . . . . . . . . . . . . . . . . . . . . . . . .453.3 Proper Handwashing Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . .45

3.4 Gloves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47

3.5 Clothing, Hair Restraints, Jewelry . . . . . . . . . . . . . . . . . . . . . . . . . . .48

Chapter 4 – Safe Food Handling . . . . . . . . . . . . . . . . . . . . . . . . .59

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vi Contents

4.1 Receiving, Storage and FIFO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60

4.2 Minimum Cooking Temperatures . . . . . . . . . . . . . . . . . . . . . . . . . . .64

4.3 Thermometer Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67

4.4 Holding Temperatures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .694.4.1 Hot Holding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70

4.4.2 Cold Holding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71

4.4.3 Using Time as a Public Health Control for Food Safety . . . . . . . . .72

4.5 Cooling Foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73

4.6 Thawing Foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76

4.7 Freezing to Control Parasites in Fish . . . . . . . . . . . . . . . . . . . . . . . . .77

4.8 Date Marking Requirements for Ready-To-Eat Potentially Hazardous

Food (Time/Temperature Control for Safety Food) . . . . . . . . . . . . . . .784.9 Cross Contamination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80

4.10 Checking Product Temperatures . . . . . . . . . . . . . . . . . . . . . . . . . . .82

4.11 Returned Food and Re-Service of Food . . . . . . . . . . . . . . . . . . . . . .83

Chapter 5 – Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93

5.1 Food Equipment, Cleaning and Sanitizing . . . . . . . . . . . . . . . . . . . .94

5.2 Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94

5.3 Sanitizing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97

5.4 In-Place Cleaning and Sanitizing . . . . . . . . . . . . . . . . . . . . . . . . . . .995.5 Chemical Usage and Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100

5.6 Types of Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101

5.6.1 Refrigeration Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102

5.6.2 Cooking Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103

5.6.3 Manual Warewashing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104

5.6.4 Warewashing Machines . . . . . . . . . . . . . . . . . . . . . . . . . . . .105

5.7 Storage of Clean Utensils and Equipment . . . . . . . . . . . . . . . . . . . .106

5.8 Cleaning and Maintenance Schedules . . . . . . . . . . . . . . . . . . . . . .106Chapter 6 – Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117

6.1 Facility Layout, Design and Construction . . . . . . . . . . . . . . . . . . . . .118

6.1.1 Floors, Walls, and Ceilings . . . . . . . . . . . . . . . . . . . . . . . . . .118

6.1.2 Lighting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119




6.2 Handwashing Sinks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .120

6.3 Chemicals and Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121

6.4 Waste Management Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . .122

6.5 Pests and Pest Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1236.5.1 Flies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123

6.5.2 Cockroaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .124

6.5.3 Rodents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .125

6.5.4 Integrated Pest Management . . . . . . . . . . . . . . . . . . . . . . . . . .126

6.6 Potable and Non-potable Water . . . . . . . . . . . . . . . . . . . . . . . . . .127

6.7 Cross Connection Control and Backflow Prevention . . . . . . . . . . . . .128

6.8 Imminent Health Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129

Chapter 7 - Hazard Analysis Critical Control Points (HACCP) . . .1397.1 What is HACCP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140

7.2 Food Safety Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141

7.3 The Seven Principles of HACCP . . . . . . . . . . . . . . . . . . . . . . . . . . .142

7.3.1 Conduct a Hazard Analysis . . . . . . . . . . . . . . . . . . . . . . . . . .144

7.3.2 Identify Critical Control Points . . . . . . . . . . . . . . . . . . . . . . . . .144

7.3.3 Establish Critical Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145

7.3.4 Monitor Critical Control Points . . . . . . . . . . . . . . . . . . . . . . . . .146

7.3.5 Establish Corrective Actions . . . . . . . . . . . . . . . . . . . . . . . . . .1477.3.6 Validation and Verification . . . . . . . . . . . . . . . . . . . . . . . . . . .148

7.3.7 Recordkeeping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .149

Appendix A – Bacteria, Viruses and Parasites Tables . . . . . . . .157

Appendix B – Training Your Employees . . . . . . . . . . . . . . . . . . .163

Appendix C – Response to Foodborne Disease Outbreaks . . . . .167

Glossary of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177

Web Sites and Publications on Food Safety . . . . . . . . . . . . . . . .179

Recognized Exam Providers . . . . . . . . . . . . . . . . . . . . . . . . . . .183

Chapter Quiz Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .185

FDA Forms (Inspection, Health Screening, HACCP) . . . . . . . . . . . . . . . .187

Posters (Cooking Temperatures and Handwashing) . . . . . . . . . . . . . . . . .193

Contents vii




About This Book

• This course is designed for best presentation when delivered in conjunction with the NSFHealthGuard™ Training CD-Rom available from NSF for NSF recognized trainers.

• NSF encourages trainers who want to use this course to apply to be an NSF recognizedtrainer by completing the trainer application form at www.nsf.org/cphe.

• This course can be taught in 8–16 hours, depending upon the local training requirements.The training can be delivered as full day sessions or divided into blocks that fit into workschedules.

• This course will prepare food managers for any of the CFP recognized food managerexams including Thompson Prometric, and the National Registry of Food SafetyProfessionals exams. Exam ordering information can be found at the back of this book.

• NSF International can customize the contents or presentation of this book to meet your

organization’s specific training needs.• Additional training materials and formats, including self-paced CD-ROM training materials

and NSF HealthGuard® online training are available from NSF.

• This book reflects the 2005 Food Code. A summary of changes can be found athttp://vm.cfsan.fda.gov. The major changes of interest are:

• Updated to reflect the new form for potentially hazardous food (potentially haz-ardous food (time) temperature control for safer food)

• Revised to identify non-potentially hazardous (TCS)

• New section on returned food and re-service of food

• New section on using time as a public health control for food safety

• New section on date marking

• New section on freezing to control parasites in fish

• Addition of Norovirus to list of diagnosed diseases from which the employee mustdisclose to the person-in-charge of the establishment

• Reflects the new term hand antiseptic to replace hand sanitizer

• Adds option on shellstock identification

• Please verify that your local authority has adopted the latest Food Code.

xiii



2 NSF HealthGuard™ Professional Food Manager Certification

1.1 Introduction toFoodborne Illness

In order to appreciate the value of food sanitation andfood safety, one needs to understand what can happenwhen food becomes unsafe. When basic principles offood sanitation are ignored and unsafe food is served tothe customer, the potential for illness exists. A food-borne illness is any infection or illness that is trans-ferred to people by the food they eat.

Recent estimates indicate that foodborne illness is respon-sible for approximately 76 million illnesses and 5,000

deaths per year in the United States. Roughly325,000 Americans will require hospitaliza-tion this year because of something they ate.

It is difficult to accurately determine the totalcost of foodborne illness in terms of medicalcosts, reduced productivity, lost wages, andhuman suffering. However, most experts agreethat the annual cost of foodborne illness in theUnited States is somewhere between 10 and83 billion dollars.

While the total impact of foodborne illness on the econo-my is difficult to measure, the cost to an individual foodestablishment is usually much more apparent. An estab-lishment that is implicated in a foodborne illness investi-gation can expect a significant loss of customers andsales, increased insurance premiums, reduced employeemorale, loss of reputation within the community, legalfees if lawsuits are filed, and in some cases, closureordered by the local health department. In the event that

an establishment is proven to have been the source of afoodborne disease outbreak, the cost to the establishmentwill be substantially greater.

The 2005 FDA Model Food Code defines afoodborne disease outbreak as “the occurrenceof two or more cases of a similar illness resulting from the

Foodborne Illness: anyinfection or illness that istransferred to people by thefood they eat.

Foodborne Disease Out-

break: the occurrence oftwo or more cases of similarillness resulting from theingestions of a commonfood.

FDA: an agency of the U.S.government that regulates thesafety of food and drugs andis responsible for developingthe Model Food Code.

Model Food Code: a set of

rules and requirements devel-oped by the FDA to ensurefood safety.



ingestion of a common food.” Itcan be very difficult to determinewhen a foodborne outbreak hasoccurred. There are several rea-sons for this. It is estimated thatmany foodborne illnesses are notreported. Despite the fact thatfoodborne illnesses can some-times be life-threatening, individu-als who have milder symptomsmay shrug off the illness as a“stomach flu” or “24-hour bug.” These people are lesslikely to seek medical treatment or report the condition to

their doctor or local health department. Second, many ofthe microorganisms that cause foodborne illnessesmay also be transmitted through drinking water or byperson-to-person contact, making it difficult to determineif an illness is actually foodborne.

1.1.1 People at RiskIt is possible that several people eating a meal togethermay consume the same foodborne pathogen, but only

some of them develop an illness. This is because somepeople are at a higher risk of contracting foodborne ill-ness than others. Adults are less likely to get a foodborneillness if they are healthy and in good physical condi-tion. People with a higher risk for contracting foodborneillness include young children, the elderly, pregnantwomen, individuals taking certain medications, andthose with weakened immune systems. Infants and

young children are more susceptible because theirimmune systems are not as fully developed as an adult.

Elderly people have a higher risk because the immunesystem begins to weaken with age. For individuals inhigher risk categories, the length and severity of a food-borne illness can be much greater.


Chapter 1 – Introduction to Food Safety 3

Microorganism: tiny organ-isms too small to be seen withthe naked eye.

Pathogen: microorganisms

that can cause disease.

Immune System: the partof the body that helps to fightoff disease and resist infec-tion.





Summary Foodborne illnesses are responsible for approximately 76 million illnesses

and 5,000 deaths in the United States annually.

Foodborne illness is preventable.

Young children, the elderly, individuals with weakened immune systems,pregnant women, and individuals taking certain medications (such asimmunosuppressants and antibiotics) are at higher risk for contractingfoodborne illness.

Some types of food are more likely to cause a foodborne illness. Thesefoods are commonly referred to as potentially hazardous foods.

A ready-to-eat food is one that receives no further washing or cookingprior to being eaten. Because these foods receive no further washing orcooking, contamination of these foods will likely be passed directly to theconsumer.

The five key risk factors that can result in, or contribute to, foodborne ill-ness are:

• Food held at improper temperature.

• Inadequately cooked or “undercooked” food.

• Contaminated food equipment (cross contamination).• Food from an unsafe source.

• Poor personal hygiene practices.

It is the right of the consumer, when purchasing food, to receive a safeproduct that will not cause harm or illness.

The primary responsibility of any food establishmentis to ensure food safety.

The FDA Model Food Code recommends that the

person in charge be responsible for ensuring compli-ance with the Food Code, and being a certified foodprotection manager or demonstrating knowledge offood safety.




______ Cooked Beans ______ Fish

______ Banana ______ Flour

______ Shellfish ______ Garlic in Oil Mixtures

______ Milk ______ Raw Sprouts

______ Peanuts ______ Hot Fudge

______ Shell Eggs ______ Candy Bar

______ Beef ______ Dry Pasta

______ Pork ______ Baked Potato

______ Cooked Rice ______ Peanut Butter

______ Tofu ______ Sliced Melon

______ Poultry ______ Commercial Mayonnaise

______ Boxed Cereal ______ Pretzels

______ Yogurt ______ Fresh Broccoli

______ Mustard ______ Lobster

Introduction to Food Safety Activity #1A potentially hazardous food (PHF) is defined as: one that supports growth of

microorganisms or has been involved in foodborne disease outbreaks.

Which of the following are considered potentially hazardous foods?





Introduction to Food Safety Activity #2




Let’s Discuss…

The local health department received a complaint from aperson who believed he contracted “food poisoning”

from eating at a local restaurant a few days earlier. Thecustomer ate dinner at the restaurant on Monday andhad a chicken caesar salad, a diet soft drink, and didnot order dessert. The following afternoon, he beganexperiencing stomach cramps, headache, nausea, fever,and diarrhea.

Upon inspection of the restaurant, the health inspectornoted that the commercial caesar salad dressing wasbeing stored in a small refrigerator near the wait station.

The temperature of the dressing was 38°F (3°C).

The inspector found that the chicken used in the saladwas stored in a large container in the front of the walk-incooler. The manager explained to the inspector that the

chicken is grilled in large batches eachmorning, cut up, and then placed in acovered container at the front of the

walk-in. Because the chicken is also usedin the chicken alfredo and the chicken teriya-

ki, they usually needed to prepare more afterthe lunch rush. The manager explained thatwhenever new batches were made, theywere placed in a clean, separate container

and the empty container was taken to thedishwasher.

At the time of the inspection, the cook happened tobe preparing another batch of chicken. The inspector

checked the temperature of the chicken in the walk-in

refrigerator that was apparently made earlier in the dayand found it to be at 58°F (14°C). He then took a sam-ple of the chicken and placed it in a sterile plastic bag ina cooler to take back to the lab. A few minutes later henoticed the cook dumping a new batch of chicken intothe same container on top of the chicken left over from





lunch. This new batch of chicken was at 105°F (40°C).The inspector noted that the cook never checked the tem-perature of the chicken.

The inspector informed the manager that he believed thechicken was not being cooled properly and that the newbatch of chicken just placed in the walk-in may havebeen contaminated by the old batch to which it wasadded. The inspector asked the manager to throw awaythe chicken.

1) Is it possible that this customer got sick fromeating the chicken caesar salad?

2) Is it appropriate for the inspector to have the

suspect chicken thrown out?

3) Has the warranty of sale been violated? Whyor why not?

At the lab, analysis of the cooked chicken samplerevealed high levels of salmonella bacteria. Over the nextfew days, 14 new cases of foodborne illness werereported by people who ate at the restau-rant on either Monday or Tuesday. Of

the 14 new cases, nine ate the chickencaesar salad, three ate the chicken Alfredo,and two ate the chicken teriyaki. Two of the peoplewho became ill were sick enough to requirehospitalization. One was a woman in herearly 70s, and the other was a two-year-oldboy who ate pieces of chicken from hismother’s plate. Both people whoreceived medical attention testedpositive for the same strain of salmo-

nella that was found on the chicken.

4) Is there enough proof that the chicken causedharm? If so, who is responsible?

5) Why do you suppose more people became illafter eating the chicken caesar salad?

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