ServSafe Manager guideFood-safety concepts
ServSafe “Big 6” Pathogens and Employee Health
The six illnesses a food employee must be able to report are not one symptom and not one return-to-work date. Vomiting or diarrhea excludes first.
Short answer
FDA Food Code 2022 section 2-201.11 requires a food employee to report a diagnosis of norovirus, hepatitis A virus, Shigella spp., Shiga toxin-producing E. coli, typhoid fever caused by Salmonella Typhi, or nontyphoidal Salmonella. Vomiting or diarrhea excludes the employee unless the symptom is from a noninfectious condition. The six illnesses do not share one return-to-work rule. A manager reports and restricts or excludes. A manager does not diagnose.
The six names, and what they are for
Study materials call these the “Big 6.” The Food Code lists them as illnesses a food employee or conditional employee must report to the person in charge when diagnosed by a health practitioner:
| Illness in section 2-201.11 | What not to flatten it into |
|---|---|
| Norovirus | “Any stomach bug for 24 hours, then back to work” |
| Hepatitis A virus | A jaundice rule with no onset date |
| Shigella spp. | The same reinstatement as norovirus |
| Shiga toxin-producing E. coli | A single stool-test story for every germ |
| Typhoid fever (Salmonella Typhi) | Nontyphoidal Salmonella |
| Salmonella (nontyphoidal) | Typhoid fever |
Salmonella Typhi and nontyphoidal Salmonella are both on the list, and they are not the same illness. The December 2024 supplement to the 2022 Food Code still treats their removal from exclusion or restriction as separate paths, and both can require approval from the regulatory authority.
The decision that does not wait for a name
Section 2-201.12 tells the person in charge to exclude a food employee who is symptomatic with vomiting or diarrhea, except when the symptom is from a noninfectious condition. You do not need to decide which of the six it is before that exclusion.
Jaundice has its own line: exclude if the onset was within the last 7 calendar days, unless a health practitioner writes that the jaundice is not caused by hepatitis A or another fecal-oral infection.
Highly susceptible populations change some restriction and exclusion details later in that section. A nursing-home kitchen is not automatically the same case as a general restaurant. Read the population before you copy a chart from a different operation.
Reinstatement is section 2-201.13. It is approval plus a condition that depends on the illness, such as written medical documentation or a time after symptoms stop. This page will not print one “48 hours and you are cleared” rule for all six. That sentence is true of some exposure timelines and false as a universal return-to-work rule.
What the manager is not doing
Recognizing a report is not diagnosing the employee. Do not tell a coworker they “have norovirus” because they vomited once. Do not use this guide as medical advice. Send an emergency the way the workplace already directs.
Practice the first call: symptom, then diagnosis, then the population. Handwashing and sanitizer still matter, and they do not replace exclusion. Cleaning steps are on the sink page.
Trust the source
Official sources
Exam policies can change. Use these primary sources for the most current details.