Manager Informed Consent and Interview Form 2023 EHS-Net Food Safety Culture Study
Contents Manager Informed Consent and Interview Form 2023 EHS-Net Food Safety Culture Study............ccssssseeeees 1 Manager Informed Consent scsi: ssivecsnseescescnavssssncsssecacossseissunsstcenuausonanns sendavestusdeswntaessanans saaassnscaacosivecsousnieeuad 2 NMatliager DEMmOBra pie siciiiesecvincecenicnseeritietnnrcenaienctandacnutensiats eedienicentiendien atau rnnelneennteineeaeesn ewes 3 Restaurant Demographic/Classification ...........ccccccccecececececececececececececececececececececeeeceeeeeseeeeeeeeececeeeeeeeeneneeeeees 4 FOGd Sarety Pcie sis sani sascpesuteicsnicencsnxecsactan caussocranncachsxacmenacavecads ceaeennsnas paasbsuevennatedodnn ceusmeauiineasiaxessennddees 7
Page 1 of 12 — Manger Informed Consent and Interview Form (2023 EHS-Net Study)
Form Approved OMB Number: 0920-0792 Expiration Date: 9/30/2018
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/information sources, gathering and maintaining the data/information 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 to: CDC/ATSDR Information Collection Review Office, MS D-74, 1600 Clifton Road, NE, Atlanta, GA 30333 ATTN: PRA (0920-0792).
Notes:
Instructions to the data collector are italicized. Only bold text is to be read aloud by the data collector. For answer options, boxes (Q) mean that there could be multiple answers to the question, while circles (O) mean that there is only one answer to the question.
Manager Informed Consent
[To the data collector: Read the following paragraphs aloud.|
Let me tell you why | am here. | am working with [INSERT HEALTH DEPARTMENT NAME] on a project looking at the food safety beliefs and practices in restaurants. Research has shown that restaurant policies and employee beliefs can impact food safety. Your restaurant was picked at random to be a part of this project. Participation is voluntary. You can choose to stop at any time. Whether you are a part of the study will not affect your restaurant’s score (or fines if applicable) on any health inspection.
Having said that, | need to let you know that if at any time during my visit | see something that is an imminent health hazard, such as no power or water, or sewage backing up in the restaurant, | will need to stop what | am doing and report the problem to [INSERT HEALTH DEPARTMENT NAME OR THE APPROPRIATE REGULATORY AUTHORITY].
| am going to ask you some questions about your restaurant and its policies. If any of the questions make you uncomfortable, you can choose not to answer them. The information | collect today will be combined with information from other restaurants in other states. While | do have your restaurant’s name and address, they will remain with me and be destroyed at the end of the study. The data we collect will only be reported with a coded identifier, and the key will not be provided to anyone else.
The information you provide will be valuable in understanding some of the tough issues that restaurants face, so we ask you to be as open and honest as you can.
The interview portion should take approximately 20 minutes. After the interview, | also would like to provide a survey to your workers, they can fill it out at their leisure, and it should take less than 10 minutes. | would then like to take a short tour of the kitchen. | would also like to leave you with a flier with a website for other employees, so they can complete the survey too.
Do you have any questions? If you have any questions later or would like a summary of the study’s findings, you can contact [INSERT LOCAL CONTACT NAME]. We expect to have all of the data summarized in about a year and a half.
Page 2 of 12 — Manger Informed Consent and Interview Form (2023 EHS-Net Study)
Manager Demographic
[To the data collector: Read the following paragraph aloud.]
I'd like to ask you some questions about yourself and this restaurant. Please be as open and honest as possible. The results will be merged with information from other restaurants, and no identifying information from this restaurant will be reported. The first few questions are about your experience.
1. How many years have you worked in food service? O Less than 1 year O 1-5 years O 6-10 years O 11-15 years More than 15 years
O
2. Have you ever had food safety training? O Yes O No
3. Have you ever been a Certified Food Protection Manager (such as by passing an ANSI-accredited program such as ServSafe, Prometric, National Registry of Food Safety Professionals, 360Training, or AboveTraining)? O Yes O No O New York City
a. Ifthe answer to question 3 is “Yes,” is the certification still valid? O Yes O No
4. What title would best describe your position? [To the data collector: Read options aloud.] General manager
Assistant manager
Kitchen manager
Owner
Shift supervisor
Other (please specify):
OCO0000
5. Approximately how long have you been employed as a kitchen manager in this establishment?
O Less than 6 months OQ 6months to less than a year O 1year to less than 2 years O 2years to less than 4 years O 4years to less than 6 years O 6years to less than 8 years O 8 years to less than 10 years O 10 years or more O Refused
6. Does the restaurant’s food safety performance rating, such as inspection scores, affect your pay? O Yes O No O Unsure O Refused
Page 3 of 12 — Manger Informed Consent and Interview Form (2023 EHS-Net Study)
Restaurant Demographic/Classification
[To the data collector: Read the following sentence aloud.]
Now, I’d like to ask some general questions about this restaurant.
7. Is this restaurant independently owned or part of a local, regional, or national chain? Independent
Local chain
Regional chain
National chain
Unsure
Refused
Other (please specify):
OCO0O0000
8. Which of the following options best describes the restaurant’s style? [To the data collector: Read options
Q — io) © Q —S
Family style
Fast casual
Fast food
Fine dining
Buffet
Café/Bistro
Other (please specify):
OCO0O0000
9. What is the seating capacity of this restaurant? [Should be located on the Certificate of Occupancy] O Capacity: O Unsure O Refused
10. What is your approximate sales per customer? O Sales per customer in dollars: O Unsure O Refused
11. What is your approximate average number of transactions or tickets per day? OQ Number of Transactions: O Unsure O Refused
12. Approximately how many meals are served here daily? OQ Number of Meals: O Unsure O Refused
Page 4 of 12 — Manger Informed Consent and Interview Form (2023 EHS-Net Study)
13. What is the establishment's busiest day, in terms of number of meals served? Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Unsure
Refused
OCOO0O00000
14. How many people work here including employees and managers that have food handling duties including prepping, cooking, or plating food? C1) Number of Managers: 1 Number of Employees: O Unsure O Refused
15. How many of these employees do you have to replace on average every month? OQ Number of employee turnovers: O Unsure O Refused
16. In general, what is the average length of employment for: a. Managers O Length of employment for managers in years: O Length of employment for managers in months: OQ Unsure O Refused
b. Cooks
O Length of employment for cooks in years: O Length of employment for cooks in months: O Unsure
O Refused
17. How often do you review the restaurant’s profit and loss statement? Daily
Weekly
Monthly
Annually
Never
Unsure of frequency
Doesn’t know what this is
Reviewed by accountant / business manager Refused
Other (please specify):
OCOOQ0O000000
Page 5 of 12 — Manger Informed Consent and Interview Form (2023 EHS-Net Study)
18. How often do you review the restaurant’s prime costs (total cost of goods sold plus total labor cost)? Daily
Weekly
Monthly
Annually
Never
Unsure of frequency
Doesn’t know what this is
Reviewed by accountant / business manager Refused
Other (please specify):
19. What language(s) do you and other managers in this establishment speak fluently? [Check all that apply.]
English
Spanish
Chinese (any dialect) French
Japanese
Other (please specify):
OOOOOO0 OC0O00000000
20. In your opinion, how well do you communicate verbally with your food workers: Excellent, very well, somewhat well, passably, or not well at all?
Excellent
Very well
Somewhat well Passably
Not well at all Unsure / Don’t know Refused
21. What is the primary language of the employees that work in this restaurant? [Check all that apply.] English Spanish Chinese (any dialect) French Japanese
Other (please specify):
OOOOOO0E O0OC0C00O0O
22. Is the manager over the kitchen a Certified Food Protection Manager? Yes
No
Unsure
Refused
OOOO
ba
If the answer to question 22 is “Yes,” is the certification still valid? O Yes O No
Page 6 of 12 — Manger Informed Consent and Interview Form (2023 EHS-Net Study)
23. Does the restaurant have a Certified Food Protection Manager for all hours of operations? Yes
No
Some hours
Unsure
Refused
OO000
24. How many employees and managers in this restaurant are Certified Food Protection Managers? 1 Number of Managers: C1 Number of Employees: O Unsure O Refused
25. Does this restaurant allow employees to handle ready to eat foods with their bare hands? O Yes O No O Unsure O Refused
a. Is bare-hand contact allowed by regulatory? O Yes O No
Food Safety Policies
[To the data collector: Read the following sentence aloud. ]
| would now like to ask you some questions about this restaurant’s policies.
26. For the following practices, could you tell me if you have a policy, and if you do, if it is written or verbal? [Check all that apply. Check the box if YES. If a policy is partially written and partially verbal, mark both the written and verbal boxes.]
a. Monitoring cooking temperatures Policy exists
Written
Verbal
Not applicable
Unsure
Refused
o OQOOOO0
ooling of foods Policy exists Written Verbal
Not applicable Unsure Refused
Ooono0oo
Page 7 of 12 — Manger Informed Consent and Interview Form (2023 EHS-Net Study)
Cold holding of food Policy exists Written
Verbal
Not applicable Unsure
Refused
ot holding of food Policy exists Written Verbal Not applicable Unsure Refused
eheating of food Policy exists Written
Verbal
Not applicable Unsure Refused
Policy exists Written Verbal
Not applicable Unsure Refused
» OQQOOQOOOO, OOO0OOOOsrw OOOCOOOOz Ooononondo
Policy exists Written Verbal
Not applicable Unsure Refused
v7 OOOQOOO0O
reventing cross-contamination of food Policy exists
Written
Verbal
Not applicable
Unsure
Refused
Ooonoouo
ate-marking and disposition of ready-to-eat TCS or potentially hazardous foods
eceiving of foods / Checking temperatures
Page 8 of 12 — Manger Informed Consent and Interview Form (2023 EHS-Net Study)
Preventing bare-hand contact with ready-to-eat foods
Policy exists Written Verbal
Not applicable Unsure Refused
anaging ill workers Policy exists Written Verbal Not applicable Unsure Refused
ooouoOoOs coonnoaga
Cleaning of food contact surfaces Policy exists
Written
Verbal
Not applicable
Unsure
Refused
eaning the establishment Policy exists Written Verbal Not applicable Unsure Refused
anaging food allergies Policy exists Written Verbal Not applicable Unsure Refused
z7 OOOOUOzs coooooa ccoounn
Policy exists Written Verbal
Not applicable Unsure Refused
Ooonoono
esponding to incidents of vomiting or diarrhea in the restaurant
Page 9 of 12 — Manger Informed Consent and Interview Form (2023 EHS-Net Study)
27.
28.
29.
30.
Are employees trained on these policies?
O Yes
O No
OQ Some
O Unsure
O Refused
[If No, Unsure, or Refused, go to question 28.]
a. How are employees trained on these policies? [Check all that apply.]
Posted policies
Provided with policy manual Part of initial training
From coworkers
Classroom
Other (please specify): Unsure
Refused
OOOOOOO00
What methods do you use to ensure that the policies are being followed? [Check all that apply.] Observation
Temperature logs
Supervisor check-sheets
Checklists
Other (please specify):
Unsure
Refused
OOQOOOOOO
When you hire a new employee, in general, what is the primary method used for training them? [Check all that apply.]
O Coworkers/Job shadowing O City/County training
1) Computer-based training O1 Classroom training
11 Shift meetings
O1 Video training
1] Other (please specify):
O Unsure
O Refused
Do you provide any specific food safety training beyond how employees should perform their specific job duties?
O Yes
O No
O Unsure
O Refused
[If No, Unsure, or Refused, go to question 31.]
a. What methods do you use to provide food safety training? [Check all that apply.]
Coworkers/Job shadowing City/County training Computer-based training Classroom training
Shift meetings
OOoOoOd
Page 10 of 12 —- Manger Informed Consent and Interview Form (2023 EHS-Net Study)
Video training
Other (please specify): Not applicable
Unsure
Refused
OOO0O0
31. Does this restaurant serve any raw or undercooked animal products or items that may contain an undercooked animal product (e.g., a rare steak, raw oysters, or meringue)? O Yes O No O Unsure O Refused [If No, Unsure, or Refused, go to question 32.]
a. How do you identify animal products that are served raw or undercooked to the customer? [Check all that apply.]
Menu description
Symbol on menu
Server
No disclosure
Other (please specify):
Unsure
Refused
OOQOOOOO0dO
b. Do you let customers know that they are at an increased risk for illness if they eat the animal products raw or undercooked? If so, is it for all items or just some items, such as for sushi but not for an undercooked steak?
O Yes-All items
OQ Yes-Some items
O No
O Unsure
O Refused
[If No, Unsure, or Refused, go to question 33.]
c. How do you let them know that they are at an increased risk for illness? [Check all that apply.] Menu statement
Pamphlet
Server
No reminder
Other (please specify):
Unsure
Refused
[Go to question 33.]
OOQOOOOOO
32. Would this restaurant serve a raw or undercooked animal product upon customer request? O Yes O No O Unsure O Refused
Page 11 of 12 —- Manger Informed Consent and Interview Form (2023 EHS-Net Study)
33. Do you have special date-marking procedures for ready-to-eat potentially hazardous or TCS foods, such as when they were prepared, opened, or when they should be used by? O Yes O No O Unsure O Refused [If No, Unsure, or Refused, skip a, b, c, and d.]
a. When you mark the foods, do you use the date it was prepared or the date it should be discarded? [Check all that apply.] 1 Date prepared O Discard date O Unsure O Refused
b. How many days does this restaurant keep these items for? OQ Number of days: O Unsure O Refused
c. Does this include the day it was made? For example, if it was made on Tuesday, do you start counting from Tuesday or from Wednesday? O Tuesday OQ Wednesday O Unsure O Refused
d. How do you indicate the date on the food? [Check all that apply.] Write date on food container
Day-dot
Other (please specify):
Unsure
Refused
OoOoood
[To the data collector: Do NOT read this aloud. Note the interviewee’s gender here.]
Interviewee’s gender: O Male O Female
[To the data collector: Read the following sentence aloud. ]
Thank you for your time and participation. The results of this survey will be combined with results from other surveys to provide an overall picture of restaurant food safety practices.
Site:
Establishment Code Number:
Date:
Additional Notes:
Page 12 of 12 — Manger Informed Consent and Interview Form (2023 EHS-Net Study)