Grocery Illness and Injury Daily Log

Daily log for grocery store employee illness and injury reports, covering exclusion and restriction decisions per FDA Food Code employee health policy and OSHA injury recording requirements.

Shift & Inspector Information

• Log Date
  Date this daily log is being completed.
• Shift
  Select the shift being covered by this log entry.
• Person-In-Charge (PIC) Name
  Full name of the manager or PIC completing this log (FDA Food Code §2-101.11).
• Department / Work Area
  Primary department or area covered (e.g., Deli, Bakery, Produce, Front End).

Employee Illness Report

• Did any employee report illness symptoms at or before the start of this shift?
  Includes vomiting, diarrhea, jaundice, sore throat with fever, or infected skin lesions per FDA Food Code §2-201.11.
• Reporting Employee Name(s)
  List the name(s) of employee(s) who reported illness. Enter 'N/A' if no illness reported.
• Reported Symptom(s)
  Select all symptoms reported by the employee(s). These are the Big 5 reportable symptoms under FDA Food Code §2-201.11.
• Symptom Onset Time / Duration
  When did the employee's symptoms begin? Note approximate time or duration (e.g., 'started last night', 'since this morning').
• Has the employee been diagnosed with or exposed to a reportable pathogen?
  Reportable pathogens include Norovirus, Hepatitis A, Shigella spp., Shiga toxin-producing E. coli (STEC), or Salmonella Typhi per FDA Food Code §2-201.11(A)(1).

Exclusion & Restriction Decision

• Exclusion/Restriction Decision
  Select the action taken for the reporting employee. Exclusion = removed from facility. Restriction = limited to non-food-contact duties. No Action = symptoms do not meet exclusion/restriction criteria.
• Basis for Exclusion or Restriction Decision
  Describe the specific reason for the decision (e.g., 'Employee reported vomiting — excluded per §2-201.12(A)', or 'Infected lesion on hand — restricted from bare-hand contact with RTE foods').
• Was the employee informed of the exclusion/restriction decision and the reason?
  PIC must communicate the decision and the applicable food safety policy to the employee.
• Was the employee's manager / HR notified of the exclusion or restriction?
  Notify store management and HR as required by store policy for any exclusion or restriction event.
• Return-to-Work Clearance Requirement Communicated
  Was the employee told what is required to return to work (e.g., symptom-free for 24 hours, medical clearance, negative test result per FDA Food Code §2-201.13)?

Work-Related Injury Report

• Did any work-related injury or incident occur this shift?
  Includes cuts, slips, falls, strains, chemical exposures, or any other injury occurring in the course of employment.
• Injured Employee Name
  Full name of the injured employee. Enter 'N/A' if no injury occurred.
• Nature and Location of Injury
  Describe the injury type (e.g., laceration, sprain, burn) and body part affected (e.g., right hand, lower back).
• Injury Severity / Treatment Required
  Select the level of treatment provided or required. OSHA 29 CFR 1904.7 defines recordability based on treatment beyond first aid.
• Was an OSHA 301 Incident Report initiated for a recordable injury?
  OSHA 29 CFR 1904.29 requires a completed OSHA Form 301 (or equivalent) within 7 calendar days of a recordable injury.
• Hazard or Root Cause Identified
  Briefly describe the hazard or condition that contributed to the injury (e.g., wet floor without signage, box cutter used without cut-resistant gloves, improper lifting technique).

Corrective Actions & Follow-Up

• Were immediate corrective actions taken for any illness exclusion or injury this shift?
  Examples: area cleaned and sanitized after ill employee contact, hazard corrected, PPE issued, wet floor sign placed.
• Description of Corrective Actions Taken
  Describe all corrective actions completed this shift. Include who performed the action and when.
• Are any follow-up actions pending for the next shift or management review?
  List any open items requiring follow-up (e.g., awaiting medical clearance, OSHA 300 log update, maintenance repair request).
• Follow-Up Actions Required
  Describe pending follow-up items, responsible party, and target completion date.
• PIC Signature
  Person-In-Charge signature confirming accuracy of this daily log.