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Run: Grocery Illness and Injury Daily Log

Track employee illness reports, exclusion decisions, and work-related injuries in one daily grocery log. Use it to document FDA Food Code health actions and ...

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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? critical (required)

Includes vomiting, diarrhea, jaundice, sore throat with fever, or infected skin lesions per FDA Food Code §2-201.11.

Yes No N/A

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? critical (required)

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).

Yes No N/A

Exclusion & Restriction Decision

Exclusion/Restriction Decision critical (required)

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? critical (required)

PIC must communicate the decision and the applicable food safety policy to the employee.

Yes No N/A

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.

Yes No N/A

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)?

Yes No N/A

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.

Yes No N/A

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.

Yes No N/A

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.

Yes No N/A

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).

Yes No N/A

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.

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