Food handler with diarrhoea or vomiting: R638 exclusion, reporting and return to work

A cook phones at 05:30 to say she was up all night with a runny stomach, or a kitchen hand mentions on the line that he vomited before work. You need to decide now whether they work today, when they can come back and what to write down. Getting food handler sick exclusion return to work decisions right is one of the simplest ways to prevent an outbreak, and one of the most common gaps we find.

Below is a workable procedure for any food premises, from a school kitchen to a busy takeaway.

What R638 expects of the person in charge when staff are ill

R638 puts two linked duties in place. Food handlers must not handle food while they have a condition, illness or wound that could contaminate it, and they must report relevant symptoms to the person in charge. The person in charge must make sure that people with such conditions are kept away from food handling and that food handlers are healthy, hygienic and trained.

In practice that means you need three things: a clear rule that staff understand, a way for them to report without fear, and a record showing what you decided and why.

The symptoms that mean stop work today

Send the person home, or tell them not to come in, if they have any of these:

• Diarrhoea, even a single episode, unless there is a clear non-infectious cause confirmed by a doctor.
• Vomiting.
• Fever together with a sore throat or stomach symptoms.
• Jaundice (yellowing of the skin or eyes).
• A diagnosis of a foodborne infection, such as illness caused by Salmonella, Campylobacter or certain strains of E. coli.

Do not wait to see if it gets worse during the shift. Norovirus, a common cause of vomiting and diarrhoea in staff, spreads very easily through hands, surfaces and food, and a single sick handler can affect many customers.

If someone becomes ill at work, they leave the food area immediately. Then clean and disinfect the toilet, hand basin, door handles and any surface or food they may have contaminated. Throw away exposed food in that area.

Cuts, boils and skin infections: cover, move or send home

Infected wounds and skin conditions carry Staphylococcus aureus, which can produce a toxin in food that cooking does not reliably destroy. Decide case by case:

• Clean cut, not infected: cover with a coloured waterproof plaster and a glove if it is on the hand. The person can keep working.
• Infected or weeping wound, boil or rash on hands, arms or face: move them to a task away from open food, such as stock control or handling sealed, packed goods, or send them home if no such task exists.
• Discharge from the eyes, ears or nose: keep them away from open food until it has cleared.

The food handler sick exclusion return to work rule: a medical certificate first

R638 is specific here. A food handler who has reported, or is suspected of, a disease that can be passed on through food may not handle food. The conditions it names include jaundice, diarrhoea, vomiting, fever, a sore throat with fever, and discharges from the ear, eye or nose. That person may only go back to handling food once they hand in a certificate from a medical practitioner stating that they are fit to handle food (regulation 11(2)(b)).

How long they stay away is for the doctor to decide. As a working rule, we tell staff with diarrhoea or vomiting not to come back until they have been free of symptoms for 48 hours, without medicine that stops diarrhoea. The 48 hours comes from international fitness to work guidance (the UK Food Standards Agency guidance is the most widely cited example), not from R638, so treat it as a minimum and never as a replacement for the certificate.

Tell the doctor that the person handles food, so the certificate says what you need. Expect the doctor to take longer, and possibly ask for tests, when:

• The person was diagnosed with a foodborne infection. Typhoid and some other foodborne diseases are notifiable medical conditions in South Africa, and the treating doctor and health authorities decide when the person may return, which can include stool tests.
• Symptoms lasted more than a few days or came back.
• There was jaundice.
• Several staff, or staff and customers, were ill at the same time.

On return, check the certificate, file it in the confidential illness file, have a short conversation and record it. Remind them about handwashing and watch them wash their hands at the start of the shift.

A short scenario

A takeaway in Mamelodi had three staff report vomiting over two days in winter. The owner’s plan was to “keep the strong ones working”. We advised a different approach: all three stayed home until they were 48 hours symptom free and had a medical certificate of fitness, the kitchen was deep cleaned with a disinfectant effective against norovirus, ready-to-eat items prepared on the affected days were discarded, and the owner phoned the local EHP to report the cluster. Nobody else became ill, and the EHP had a clear, dated record of what was done.

Do food handlers need a medical certificate in South Africa?

This is one of the questions we are asked most, and the answer has two parts. R638 does not ask every food handler to hold a routine medical certificate before starting work, or to renew one every year. What it does ask for is a certificate from a medical practitioner, stating that the person is fit to handle food, before someone who was kept off food handling because of an illness that can be passed on through food goes back to work.

Some municipalities, clients, contracts and certification schemes also ask for pre-employment medicals. Check with your municipality, your clients and, if you are certified, your certification body. A routine certificate only shows that someone was well on the day of the appointment, so use it alongside a health declaration and a reporting rule, never instead of them.

Recording illness without breaking POPIA

Health information is special personal information under the Protection of Personal Information Act (POPIA), so treat it carefully. A sensible approach:

• Record only what you need: date reported, the general symptom category (for example “gastro symptoms”), the decision taken, date returned and who authorised the return.
• Do not record diagnoses or medical detail you do not need for food safety.
• Keep the illness log and any medical certificates in a locked file or a restricted folder, separate from the general staff file.
• Tell staff why you keep the record and who sees it. Include this in your induction and staff policy.

Date	Staff member	Symptom category	Action	Return date	Cleared by
14 October 2026	T. Mokoena	Gastro symptoms	Sent home, area cleaned	17 October 2026	Person in charge

The Personal Hygiene Risk Assessment Template helps you set out these controls properly, so the procedure is based on your actual risks and is ready to show an EHP or auditor.

When staff hide symptoms: making it safe to report

Here is the uncomfortable truth. Many food handlers, especially casual and part time staff, cannot afford a day without pay, so they come in sick and say nothing. If your system punishes reporting, people will stop reporting.

• Explain sick leave entitlements clearly, and make sure supervisors apply them properly.
• Where you can, offer non food tasks to someone with a minor wound rather than sending them home unpaid.
• Thank people who report. Never make them feel like they let the team down.
• Watch for signs: frequent toilet trips, someone looking unwell, a colleague who mentions it.

This is food safety culture at the level that matters most. Our food safety culture work often starts right here.

What to do this week

• Write a one page illness and exclusion rule and put it on the staff notice board.
• Set up a confidential illness log with the columns above.
• Make sure every supervisor knows that an excluded food handler needs a medical certificate of fitness before handling food again.
• Check your first aid kit has coloured waterproof plasters.
• Talk to staff about sick leave and reporting, and make it clear reporting will not be punished.

If you are the person in charge and want to be confident about these duties, the Persons in Charge (R638) course covers staff health, exclusion and the records an EHP expects. It is SAATCA registered and HPCSA CPD accredited.

Frequently asked questions

Can a sick food handler work if they wear gloves?

No. Gloves do not stop someone with diarrhoea or vomiting contaminating food, surfaces and colleagues. Keep them out of food handling until 48 hours after symptoms stop.

What if a staff member’s child at home is sick?

Remind them about careful handwashing and ask them to report straight away if they develop symptoms. They can usually work if they are well themselves.

Do I have to tell the EHP if staff are ill?

If several people are ill, or customers report illness, contact your local EHP for advice. Foodborne disease outbreaks are notifiable medical conditions that doctors must report, so early contact from you usually helps more than it harms.