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WEST VISAYAS STATE UNIVERSITY

COLLEGE OF BUSINESS AND MANAGEMENT

GRADUATE SCHOOL
Iloilo City

Food Safety and Sanitation: Attitude and Regulations


Compliance Among Fast Food Restaurants

Kendrick A. Callao

Chapter 1
Introduction to the Study

This chapter is divided into five parts: (1) Background and Theoretical
Framework of the Study, (2) Statement of the Problem and the Hypotheses,
(3) Significance of the Study, (4) Definition of Terms, and (5) Delimitation of the Study.
Part One, Background and Theoretical Framework of the Study, outlines the
reasons for choosing the problem and theoretical framework upon which the study was
anchored.
Part Two, Statement of the Problem and the Hypotheses, identifies the main and
specific problems of the research and the hypotheses tested.
Part Three, Significance of the Study, cites the benefits that may be derived from
the results of the investigation.
Part Four, Definition of Terms, defines the important terms used in the study, both
conceptually and operationally.

WEST VISAYAS STATE UNIVERSITY


COLLEGE OF BUSINESS AND MANAGEMENT

GRADUATE SCHOOL
Iloilo City

Part Five, Delimitation of the Study, specifies the scope and coverage of
the study.
Background and Theoretical Framework of the Study
Food safety regulation in its current form has been part of the Philippine
landscape for decades. In 1976, the Code of Sanitation of the Philippines was passed and
just recently in September of 2013 the Food Safety Act of 2013 was signed by the
president. Both of these events were triggered by concerns with unsafe food products;
concerns which have persisted throughout the years as the food industry and consumers
are faced with food scares on a regular basis (DOH, 2011).
The Food and Drug Administration began to collect baseline data of food safety
practices in foodservice operations. The report of the FDA Retail Food Program Database
of Foodborne Illness Risk Factors was released in 2006 and focused in and explored
major risk factors that are attributed to foodborne diseases (FDA, 2004). The report
indicated that full-service restaurants were 40% out-of-compliance with overall food code
standards. Fast food restaurants were slightly better, with an overall out-of-compliance
rate of 26%. These out-of-compliance rates are higher than other noncommercial food
establishments such as hospitals, nursing homes, and elementary schools. In full-service
restaurants, the most frequent out-of-compliance practices included cooling potentially
hazardous foods to 70oF within two hours (85%), adequate hand washing (81%), and
holding potentially hazardous foods at 41oF or below (81%). The report identified 15
practices that were in need of priority attention, the most of any operation. The most

WEST VISAYAS STATE UNIVERSITY


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common out-of-compliance practices in fast food restaurants included ready-toeat, potentially hazardous foods held for more than 24 hours (71%), holding potentially
hazardous foods at 41oF or below (62%) and prevention of hand contamination (58%)
(FDA, 2004). All of the top practices that are out-of-compliance in both fast food and
full-service restaurants are directly related to employee food safety knowledge, attitude,
and on-the-job practices of foodservice food handlers. Thus, these information and
findings motivated the researcher to conduct this study.
This study is anchored on Nightingales environmental theory of sanitation. This
theory stresses that good sanitation has a great impact on a persons health. One of the
fine essential elements according to Nightingale is good sanitation. The theory also
emphasizes that the main cause of any disease is the poor environment condition, and, to
be able to improve the environment, the people must learn to practice good sanitation in
every part of the globe. Likewise, proper health planning and environmental strategies
must be implemented in order to live a healthy and blissful life (Pescadera, 2013)
The theory of reasoned action (Ajzen and Fishbein, 1980) was also considered in
the study. This theory stresses that a person's attitude toward a behavior consists of a
belief that a particular behavior leads to a certain outcome and an evaluation of the
outcome of that behavior. If the outcome seems beneficial to the individual, he or she
may then intend to or actually participate in a particular behavior. Also included in one's
attitude toward a behavior is the concept of the subjective norm. People may also be
inclined (or not inclined) to participate in a behavior based upon their desire to comply

WEST VISAYAS STATE UNIVERSITY


COLLEGE OF BUSINESS AND MANAGEMENT

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with others. Laws or rules prohibiting a behavior may have an impact on one's
attitude toward participating in a behavior. Ultimately, one's attitude toward a behavior
can lead to an intention to act (or not to act as the case may be). This intention may or
may not lead to a particular behavior.
In this perspective, this study aimed to find out the attitude towards food safety
and sanitation of food handlers and the level of regulations compliance of fast food
restaurants.
Figure 1 shows the conceptual framework.
INDEPENDENT VARIABLE

DEPENDENT VARIABLE

Personal factors

Sex
Age
Educational
qualification
Industry
experience
Job position

Attitude towards
food safety and
sanitation

Fast food restaurant


characteristics

Restaurant size
Number of
food handlers
Restaurant type

Food safety and


sanitation regulations
compliance

Figure 1. Attitude towards food safety and sanitation and food safety and sanitation
regulations compliance as influenced by certain identified factors.

WEST VISAYAS STATE UNIVERSITY


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GRADUATE SCHOOL
Iloilo City
Statement of the Problem and the Hypotheses
This study aimed to ascertain the attitude of food handlers towards food safety
and sanitation, and the compliance of fast food restaurants to regulations on safety and
sanitation.
Specifically, the study aimed to answer the following questions:
1. What is the attitude of food handlers of fast food restaurants towards food
safety and sanitation when they are taken as an entire group and classified according to:
(a) sex, (b) age, (c) educational qualification, (d) industry experience, and (e) job
position?
2. What is the level of compliance to regulations of fast food restaurants taken as
entire group and classified according to: (a) restaurant size, (b) number of food handlers,
and (c) restaurant type?
3. Are there significant differences in the attitude of food handlers of fast food
restaurants towards food safety and sanitation when they are classified according to: (a)
sex, (b) age, (c) educational qualification, (d) industry experience, and (e) job position?
4. Are there significant differences in the level of compliance to regulations of
fast food restaurants classified according to: (a) restaurant size, (b) number of food
handlers, and (c) restaurant type?
5. Is there a significant relationship between the food handlers attitude towards
food safety and sanitation and the fast food restaurants compliance to regulations?

WEST VISAYAS STATE UNIVERSITY


COLLEGE OF BUSINESS AND MANAGEMENT

GRADUATE SCHOOL
Iloilo City

In view of the preceding problems, the following hypotheses are


advanced:
1. There are no significant differences in the attitude of food handlers of fast food
restaurants towards food safety and sanitation when they are classified according to: (a)
sex, (b) age, (c) educational qualification, (d) industry experience, and (e) job position.
2. There are no significant differences in the level of compliance to regulations of
fast food restaurants classified according to: (a) restaurant size, (b) number of food
handlers, and (c) restaurant type.
3. There is no significant relationship between the food handlers attitude towards
food safety and sanitation and fast food restaurants compliance to regulations.
Significance of the Study
The study is beneficial to the following:
Fast food restaurant owners and managers. This investigation may provide
insight to restaurant owners and managers about their existing compliance to food safety
and sanitation regulations and the requirements that they need to comply.
Employees of fast food restaurants. Employees may be informed if they comply
with safety and sanitation regulations and they will be provided with more knowledge
and useful insights in proper food handling to ensure food safety of their customers.
Hospitality educators. The results of this study may inform hospitality educators
of how much and what more to teach to students regarding food safety and sanitation.

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They may also be aware of the extent of practical training they will apply so that
the students will have ample knowledge and expertise in food handling.
Future researchers. Future researchers may use this study as a springboard of
related problems they will investigate in the future.
Delimitation of the Study
This is a study on the attitude of food handlers of selected fast food restaurants in
Iloilo city towards food safety and sanitation and the compliance of selected fast food
restaurants to food safety and sanitation regulations. The study was conducted during the
second semester of academic year 2013-2014 using the survey-correlational research
design.
To gather data on the attitude towards food safety and sanitation and the
regulations compliance of selected fast food restaurants, the researcher utilized two (2)
data gathering instruments, the Sneed and Lin (2010) questionnaire on the attitudes of
food handlers towards food safety and the Sanitary Inspection of Food Establishment
Compliance Form (2012) of the Iloilo City Health Office.
The participants of the study were the 200 food handlers of randomly selected fast
food restaurants in Iloilo city. The food handlers were taken as an entire group and
classified according to (a) sex, (b) age, (c) educational qualification, (d) industry
experience, and (e) job position. The participants were selected through two-stage
sampling.

WEST VISAYAS STATE UNIVERSITY


COLLEGE OF BUSINESS AND MANAGEMENT

GRADUATE SCHOOL
Iloilo City
The statistics that were employed in this study were frequency,
percentiles, mean, standard deviation, t-test, one-way ANOVA, Scheffe test, Kruskal
Wallis, Mann Whitney and Pearsons r. The data gathered for this study were subjected
to a certain computer-processed statistics. The .05 alpha level was used as the criterion
for the acceptance and rejection of the null hypotheses.
Definition of Terms
For clarity and better understanding of this study, important terms
used were given their conceptual and operational meanings:
Fast food restaurants--is a specific type of restaurant characterized both by its
fast food cuisine and by minimal table service (Sarda, 2013).
As used in this study, fast food restaurants referred to selected fast food
establishments in Iloilo city.
Food safety--is a scientific discipline describing handling, preparation, and
storage of food in ways that prevent foodborne illness (Ang & Balanon, 2010).
The same meaning was used in the study.
Food sanitation--is the hygienic measures for ensuring food safety (McSwane,
Rue & Linton, 2005).
The same meaning was used in the study.
Attitude--is a state of mind, feeling or disposition (McShane, 2010).
As used in this study, attitude referred to the viewpoint of selected fast food
restaurant food handlers in Iloilo city on food safety and sanitation.

WEST VISAYAS STATE UNIVERSITY


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GRADUATE SCHOOL
Iloilo City
Regulation--a rule designed to control the conduct of those to whom it
applies; regulations are official rules and have to be followed (Morris, 2008).
As used in this study, regulation referred to the mandatory requirement for
sanitary inspection implemented by Iloilo City Health Office on food establishments
Compliance--is the act or process of complying to a desire, demand, proposal, or
regimen or to coercion (Morris, 2008).
As used in this study, compliance referred to the observance of mandatory
requirements by selected fast food restaurants for sanitary inspection as implemented by
Iloilo City Health Office.

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Chapter 2
Review of Related Literature

This chapter presents literature and studies relevant to the present study. It is
divided into four parts: (1) Food Safety and Sanitation, (2) Fast Food Restaurants, (3)
Attitude and Compliance, and (4) Summary.
Part One, Food Safety and Sanitation presents literatures related to food safety
and sanitation, most of which deals with the proper practices and some implications of
malpractice.
Part Two, Fast Food Restaurants, includes studies and topics relevant to fast food
restaurants.
Part Three, Attitude and Compliance, lists related studies on attitude and
compliance of food service establishments.
Part Four, Summary, recapitulates the important ideas, studies and literature.
Food Safety and Sanitation
Food is a product that is rich in nutrients required by microorganisms and may be
exposed to contamination with the major sources from water, air, dust, equipment,
sewage, insects, rodents and employees (Ang & Balanon, 2010). Due to the changes in
food production, handling, preparation techniques, as well as eating habits, the fact
remains that food is the source for microorganisms that can cause illness. The US Centers
for Disease Control and Prevention (CDC, 2010) revealed that the outbreaks of

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foodborne diseases which resulted from foods of animal origin had caused
approximately 76 million illnesses, 325,000 hospitalizations and 5000 deaths each year.
Data obtained from UK and USA suggest that 2040% of such illnesses are associated
with the consumption of contaminated food where catering establishments are the most
frequently cited sources of sporadic and outbreak foodborne infection. The common food
handling mistakes besides serving contaminated raw food also include inadequate
cooking, heating, or re-heating of food, consumption of food from unsafe sources,
cooling food inappropriately, and allowing too much of a time lapse.
Food safety has become an issue of special importance for the retail food industry.
There are many opportunities for food to be contaminated between production and
consumption (Ang & Balanon, 2010). Food safety is especially critical in retail food
establishments because this may be the last opportunity to control or eliminate the
hazards that might contaminate food and cause foodborne illnesses. (Ang and Balanon,
2010). Even when purchased from inspected and approved sources, ingredients may be
contaminated when they arrive at the food establishment. It is important to know how to
handle these ingredients safely and how to prepare food in such a manner that the risk of
contaminated food being served to clients or customers is reduced.
Most cases of food poisoning happen in foodservice establishments and usually
afflict a great number of people. Commercial food service establishments have been
identified by the Center for Disease Control as the leading source of foodborne illness
outbreaks (Bean et al., 2006). Statistics show that in the Philippines, the second highest

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death-related illness is intestinal disease. Outbreak of foodborne illnesses could


be prevented if foodservice workers have proper training, techniques, and tools in food
management.
Food handlers play a major role in transmitting pathogens passively from
contaminated sources such as transmitting pathogens from raw meat to a ready to eat
food. Food handlers may also carry some human specific foodborne pathogens such as
Hepatitis A, noroviruses, typhoidal Salmonella, Staphylococcus aureus and Shigella sp in
their hands, cuts or sores, mouth, skin, and hair. Food handlers may also shed foodborne
pathogens, such as E. coli O157:H7 and non-typhoidal Salmonella during the
infectiousness period or less important during recovery period of a gastrointestinal
sickness (Adams & Moss, 2008).
Restaurants have a natural challenge that just comes with the territory: cleanliness
and food safety (Stone, 2011). It seems not a day goes by without another horror story in
the news about contaminated food products. Restaurants get routinely shut down by the
Health Department. Even if things dont get that bad for the business, all it takes is for a
delivery person to see a puddle of mud on the floor in the kitchen for a bad word-ofmouth campaign to start circulating about the establishment. The media reports cases of
food poisoning on a daily basis in spite of the fact that the fast food business is
flourishing. It seems fast food has become the American way and the public will go
blindly forth ordering with the exception that the food has been prepared in sanitary
conditions. From bug problems to breeding bacteria, fast food restaurants especially, have

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countless issues behind their counters. If one is the manager, awareness on


his/her part is not enough; he/she has to be vigilant in ensuring that every employee
knows and follows the rules to the letter.
One of the most common causes of food poisoning is bacteria transfer, which is
due to food not being properly cooked or kept at the proper temperature. With such a
demand for fast food, it is often all too easy for the employees to compromise their duties
for the sake of saving time, and before they know it, they have served a meal that carries
a nasty risk of food poisoning. The rules should be followed every time, not some of the
time, as is unfortunately sometimes the case. It is up to the management to see that the
employees are properly doing their job, and, of course, effective management makes all
of the difference in this endeavor. Close supervision is a necessity to help ensure that the
work is being performed properly. Employees must care about their job and in return feel
valued so that they will be more willing to perform their responsibilities correctly. Too
often, factors like low pay, long hours and little recognition make employees more likely
to burn out and do less than what is expected of them. Also, improper training of staff
leads to improper fulfillment of job duties. Unclean areas like counters or tables where
food has been prepared can also spread bacteria and cause food poisoning. That is why, it
is important for employees to clean up after themselves and make sure that their work
space is kept fastidiously clean. Also, food containers that have not been properly washed
and stock that has not been properly rotated are havens for bacteria. Lastly, employees
who do not wash their hands before returning to their work station can unknowingly

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spread bacteria and other diseases. That is why, it is of the utmost importance
that employees wash their hands. Fast food restaurants should have at least one sink
designated for hand washing only, with properly posted instructions, and including the
necessary soap, and paper towels. Wearing gloves when in contact with food helps as
added protection, but even gloves can touch unclean surfaces just like hands can, so they
need to be changed after coming into contact with unsanitary surfaces and items.
A safe working environment and sanitary atmosphere in the food service industry
are always important (Gonzales & Sandique, 2007). Two terms frequently assumed to be
one and the same are cleaning and sanitizing, but they have the same significant
differences. They reported that to damage the good name and image of an establishment,
an outbreak of illness can be expensive. There are possible legal costs combined with loss
of revenue that may force an establishment to close.
Alvarez (2010) asserted that food industry consists of food establishments
involved in the production, manufacture, transport and distribution of food. Food
production involves the activities taking place in farms, ranches, orchards and in fishing
operations. Food manufacturing includes the harvest of raw materials and converts them
into forms suitable for distribution. In addition, food processes must ensure food safety to
prevent food poisoning, spoilage and food borne diseases. It is imperative to practice
food safety by controlling the supply, maintaining sanitary facilities and training the
employees to work observing food safety. Therefore, refrigeration before the preparation
of foods is necessary to keep the foods internal temperature within the safe range. There

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should be separate areas for raw and cooked foods or meat and vegetable and
fruits. Likewise separate chopping boards must be used for raw and cooked foods.
Sanitized utensils and cutting boards must be used for raw and cooked foods. Sanitized
utensils and cutting boards should always be used to avoid cross-contamination, (Maya
Kitchen Culinary Arts Center, 2007).
The word food safety (Roldan & Edica, 2008) covers practices to: prevent the
growth and multiplication of bacteria; prevent food from contamination of bacteria, toxin
and other harmful substances; prevent food spoilage; prevent occurrence of food
poisoning and infection as well as the spread of disease; and retain nutritional and
aesthetic qualities of food. Food safety in food establishment is assured when all the
conditions of bacterial growth are controlled. This is done through time and temperature
control, proper housekeeping maintenance, proper maintenance of cooking or serving
equipment and facilities and consistent compliance to standards of hygiene, sanitation
and food safety.
Similarly Lee (2010) believes that food safety has increasingly gained the
attention of authorities worldwide from the cases of food borne outbreaks. An increase in
the diseases related to food borne illnesses has been seen from 2005 to 2008 in Malaysia.
Occurrence of food borne illnesses can be attributed to many factors, one of it is the
handling process of food preparation especially by food handlers. This is because hand
can be a vector of dissemination of pathogens through cross contamination. The Good
Hygiene Practices describes all practices regarding the conditions and measures

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necessary to ensure the safety and suitability of food at all stages of the food
chain, which is an important process that will eventually lead to the safety in the kitchen.
It covers proper storage of food items, maintenance of clean environment during food
preparation and assurance of all dishes served are clean and free of bacteria that can
potentially cause further contamination and prevent food borne illnesses.
Foodborne illnesses according to Scott and Herbold (2010) pose a problem to all
individuals but are especially significant for infants, the elderly, and individuals with
compromised immune systems. Personal hygiene is recognized as the number-one way
people can lower their risk. The majority of meals in the U.S. are eaten at home. Little is
known, however, about the actual application of personal hygiene and sanitation
behaviors in the home.
Roldan and Edica (2008) asserted that cases of foodborne diseases can cause
irreparable damage to the reputation of a food establishment. One single case of food
poisoning can already discourage diners from coming back to the restaurant or canteen. A
hygienic food handler can be an instrument in transmitting bacterial contamination and
food borne disease. It is therefore important for every server to understand and practice
the rules of safety in handling and serving food. Food borne diseases come from bacteria
or microorganisms. These are tiny, living and active being that rapidly multiply in
numbers under the right conditions. For example, when a kitchen or dining area is not
properly maintained in terms of cleanliness and sanitation, it becomes vulnerable to the
growth and multiplication of microorganisms or bacteria as well as pests. When this

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happens, diners suffer from typhoid fever, hepatitis and other related diseases. In
addition, bacteria breeds in unsanitary, moist and slightly acidic environment like: dirty
surroundings, wet, undisposed and uncovered garbage, stagnant and dirty water, crowded
places like storerooms that are dirty, undisposed, uncovered left-over foods and dirty and
unsanitized containers, pans and utensils.
Foodborne illness or disease is a disease carried or transmitted to people by food.
Payne and Theis (2006) further discussed that a more inclusive statement defines food
borne illness as any illness or injury that results from something that has been eaten. Any
food that is not fit for human consumption is spoiled. A spoiled food, however, does not
necessarily have the potential to cause foodborne illness. Conversely, an unspoiled food
is not necessarily safe to eat. Any food containing dangerous levels of microorganisms,
toxins, chemical or physical contaminants, has the potential to cause food borne illness.
Foodborne illness or disease is a disease carried or transmitted to people by food. A more
inclusive statement defines foodborne illness as any illness or injury that results from
something that has been eaten.
Galvez (2007) believes that foodborne disease is caused by the consumption of
food items that are contaminated by dangerous microorganisms also known as germs of
microbes. This simply means that food borne illness is an illness that is carried by the
food. This often referred as food poisoning by many professionals in the hotel and
restaurant industry. Nevertheless, this term does not only constraint to a contaminated
food but as well to contaminated beverages. Therefore, a person suffering from

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foodborne illness may experience the symptoms like diarrhea, vomiting, nausea,
muscle cramps, stomach ache, body weakness and dehydration.
Microorganism that cause food borne illness cannot travel on their own and
contaminate food, but the microorganisms are transferred through the food via a process
of cross contamination. For example, if an infected worker touches or get into contact
with a food, he/she contaminates it. Although, cross contamination from an infected
person may not be the only way that a food item may be contaminated, they could also be
contaminated through the following: exposed to unsafe temperature for a long period of
time, improper packaging of food items, poor hygiene and sanitation during the
preparation of the food, improper reheating of food, and unsafe sources and suppliers.
Cushman (2007; cited in Dirks, 2010), reported that foodborne illness outbreaks
are on the rise and food safety continues to be a major concern since foodborne illnesses
have potentials to attack patrons through a variety of ways. In a study conducted by
Hedberg et al. (2006) to investigate the differences between outbreak and non-outbreak
restaurants, researchers found that Norovirus, a RNA virus known for gastroenteritis
outbreaks and is transmitted fecally, was confirmed or suspected in 42% of all restaurant
food borne illness outbreaks. Bacteria Salmonella and Clostridium perfringens were the
next common microorganisms found in outbreaks that accounted for 19% of identified
outbreaks and suspected in 28% of outbreaks. Furthermore, the contributing factors of
these outbreaks were infected employees who handled food and bare-hand contact with
food.

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McCabe-Sellers and Beattie (2004) reported that the reasons for


outbreaks include: epidemiological selection (outbreaks involving several people who are
more likely to be traced back to the source that to individual cases), lack of quality
assurance in foodservices, and most importantly a failure of food handlers to follow
critical behaviors that mitigate the potential for foodborne illness. As a result of the
different outlets for foodborne illness outbreaks, food-related scares have led to an
increase of interest in improving food safety practices in foodservice operations as well
as communicating the importance of sanitation to food workers. In addition, food will
remain safe as long as critical behaviors are observed in food handling (Dirks, 2010).
Food handlers in restaurants are epidemiologically more important than the
domestic food handlers in the spread of food borne illnesses. Mohan (2006), further
discussed that unhygienic practices like coughing and sneezing in the food preparation
area, improper hand washing, wearing dirty clothes, etc. all may introduce a variety of
microorganisms in the food.
Foodborne disease is a common, but preventable, burden of illness worldwide.
Almost one-half of every dollar spent on food in the United States is spent on food from
restaurants. A growing body of data from foodborne disease outbreaks and studies of
sporadic (non-outbreak-associated) gastrointestinal disease of various etiologies suggest
that eating food prepared in restaurants is an important source of infection. These data
suggest a critical need for action that is focused on preventing disease transmission
within the food service industry. Clinicians should report all suspected foodborne disease

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to public health authorities to ensure appropriate epidemiologic investigation


(Jones & Angulo, 2006).
There is a critical need to focus intensely on specific, modifiable risks in the food
production chain and to adopt new strategies to minimize risks even as studies and
debates continue. Restaurants must follow strict policies of safe food handling.
Consumers should avoid consumption of high-risk foods, such as undercooked eggs or
undercooked ground beef, in any venue, including restaurants. Clinicians can help to
ensure appropriate epidemiologic investigation and follow-up of suspected cases of
foodborne disease by reporting them to local public health authorities (Jones & Angulo,
2006).
More than 54 billion meals are served at 844,000 commercial food establishments
in the United States each year; 46% of the money Americans spend on food goes for
restaurant meals. On a typical day, 44% of adults in the United States eat at a restaurant.
Of a mean 550 foodborne disease outbreaks reported to the Centers for Disease Control
and Prevention each year from 1993 through 1997, less than 40% were attributed to
commercial food establishments. Preventing restaurant-associated foodborne disease
outbreaks is an important task of public health departments.
Foodborne illness continues to be a public health burden, with most recent
estimates of 9.4 million cases per year in the United States, resulting in 1,351 deaths.
While foodborne illness is not traditionally tracked by race, ethnicity or income, analyses
of reported cases have found increased rates of some foodborne illnesses among minority

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racial/ethnic populations. In some cases (Listeria, Yersinia) increased rates are


due to unique food consumption patterns, in other cases (Salmonella, Shigella,
Campylobacter) it is unclear why this health disparity exists. Research on safe food
handling knowledge and behaviors among low income and minority consumers suggest
that there may be a need to target safe food handling messages to these vulnerable
populations. Another possibility is that these populations are receiving food that is less
safe at the level of the retail outlet or foodservice facility (Quinlan, 2010).
Foodborne illness continues to be a public health burden, with most recent
estimates of 9.4 million cases per year in the United States, resulting in 1,351 deaths. The
Foodborne Diseases Active Surveillance Network (2012), quantifies and monitors the
incidence of laboratory-confirmed cases of Salmonella, Campylobacter, Listeria, Shigatoxin producing E. coli, Shigella, Yersinia and Vibrio. The FoodNet catchment area was
not chosen to equally represent all racial and ethnic groups and even in the expanded
FoodNet population, Hispanics and those living below the poverty level are
underrepresented when compared to the general American population (6% vs. 12%, and
11 vs. 14%, respectively). Over the past decade, analysis of FoodNet tracking data to
examine the burden of foodborne illness on minority racial and ethnic populations has
revealed trends related to their demographics. Additionally, since 2008, FoodNet final
reports each year have reported incidence rates of bacterial pathogens by race and
ethnicity.

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Restaurants in the United States are regularly inspected by local, county,


or state health department personnel. The guidelines of the U.S. Food and Drug
Administration (2008) state that a principal goal to be achieved by a food establishment
inspection is to prevent foodborne disease. Although restaurant inspections are one of a
number of measures intended to enhance food safety, they are a highly visible
responsibility of local health departments. In many parts of the country, restaurant
inspection scores are easily accessible to the public through the Internet or are
disseminated through local news media. An inspection system that effectively addressed
the goal of improving food safety would be uniform, consistent, and focused on
identifying characteristics known to affect food safety.
Foodborne infections can cause severe illnesses in the general population
including healthy adults. However, older adults (those who are over 60 years old) tend to
have more severe complications to these infections. Also, research has shown that elderly
persons are more susceptible to foodborne illness infections and deaths (Buzby, 2002).
According to Lee, Renig and Shanklin (2007) food quality involves more than
food safety. Taste is just as important. In fact, during the research conducted by Lee et
al., food quality was a consideration for those who have looked into assisted living
facilities. Food quality at assisted living facilities has played a part in the determination
of value received and overall quality of care received as the assisted living facilities.
According to Ricaplaza (2008), West (1997) emphasizes that regardless of the
type of foodservice, one commonly is to plan a minimum amount of space for a minimum

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job and a basis principle in planning foodservice facilities for efficient operation
is the assembly line concept, which patterned traffic for receiving, storing and sanitation
of the features of the setup are the purpose that must be kept in mind then planned the
detailed arrangement within the food service area.
Restaurants and other retail and institutional foodservice operations have become
an integral part of todays society because dining out or purchasing food to-go or readyto-prepare has become routine for most Americans. The National Restaurant Association
(NRA, 2005) reports that more than 70 billion meal and snack occasions will be eaten
daily in restaurants and cafeterias in 2008. Given the number of people who dine out, the
potential for foodborne illness resulting from food prepared in commercial foodservice
operations is great. Therefore, foodborne illness and disease should be a significant
concern for those who manage and own foodservice operations.
The Center for Disease Control and Prevention (CDC, 2010) has estimated that
foodbornerelated illnesses cause approximately six to 76 million illnesses, 325,000
hospitalizations, and approximately 5,000 deaths each year in the United States (Mead, et
al, 2007). Both known and unknown agents attribute to the wide estimate range. Between
2003 and 2007, 50% of the illnesses caused by foodborne illness outbreaks were
associated with food consumed in restaurants and other commercial food establishments.
Some of these foodborne illnesses are mild and result in 24-hour flu-like symptoms, but
many other cases have been severe enough to require hospitalization or cause death.

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The top three factors that contribute to foodborne illnesses are improper
holding temperatures, poor personal hygiene, and cross contamination. All of which are
directly related to the food handlers knowledge of food safety (Food and Drug
Administration, 2004). Previous research has suggested that food safety training is a way
to assure that proper practices are followed in restaurants, although research relating
knowledge to behavior change has been inconsistent. Studies have found that food safety
training is effective in increasing overall sanitation inspection scores in the
microbiological quality of food and self-reported changes in food safety practices
(McElroy & Cutter, 2004). Several states now mandate food safety certification for
restaurant employees. In 2002, Schilling, OConnor, and Hendrickson reported that 16
states have state-mandated certification requirements and 34 states have some form of
voluntary requirements. Several states were in the process of adopting the 2002 food code
which requires operations to have at least one employee who can demonstrate knowledge
about food safety.
Foodborne diseases remain a major public health problem across the globe. The
problem is more severe in developing countries because of lack of personal hygiene and
food safety measures. As much as 70% of diarrheal diseases in developing countries are
believed to be of foodborne origin. Foodborne disease outbreaks in hospitals have
affected patients, staff, and visitors. Mishandling food promotes pathogen growth and
disease, especially among patients with weakened immunity or achlorhydria. Although
providing safe food to patients who are at risk of getting infections is a major duty of

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hospitals, epidemiological and surveillance data suggest that faulty practices in


food- processing plants, food service establishments and home play an important role in
the causal chain of foodborne diseases (Mukhopadhyay, 2012)
Todd, Greig, Bartleson, & Michaels (2009) formed a workgroup and analyzed
816 foodborne outbreaks where food workers have been implicated in the spread of
foodborne diseases. They have published a series of peer-reviewed papers in the journal
of food protection from 2007 to 2011. In the third publication, they categorized the factor
contributing to out- breaks into food worker error factors, bacterial proliferation factors,
and important survival factors for pathogens. The most frequently reported food worker
errors were handling of food by a person either actively infected by or carrying a
pathogen, bare-hand contact with food, failure to properly wash hands when necessary,
insufficient cleaning of processing or preparation equipment or kitchen tools. Such
unhygienic practice would cause contamination of the food and cross-contamination of
ready-to-eat (RTE) foods
Food-borne diseases have been increasing in recent years, with a greater impact
on the health and economy of developing countries than developed countries (WHO,
2007). According to the World Health Organization, in 2005 alone, 1.8 million people
died from diarrheal diseases, and most of these cases were attributed to the ingestion of
contaminated food and drinking water. Meals prepared and distributed in schools should
receive special attention because the foods are intended for young children, a population
with an increased risk for several diseases due to microbial pathogens in foods. To ensure

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high quality meals for students, catering services need to follow the regulations
set forth by the Health Surveillance Committee. Despite the existence of specific
regulations, the safety measures taken during school meal preparation are still inadequate,
as most schools do not take into consideration the specific sanitary requirements needed
for the various stages of food preparation (Santana, Almeida, Ferreira, & Almeida, 2009)
Good personal hygiene and sanitary handling practices at work are an essential
part of any prevention program for food safety. Although the majority of food handlers
have the skills and knowledge to handle food safely, human handling errors have been
implicated in most outbreaks of food poisoning (Todd, Bartleson, & Michaels, 2007).
The inappropriate handling of foods by the food service industry has been implicated in
97% of food poisoning cases (Greig, Todd & Bartleson, 2007). There is no indication that
food-borne illnesses are diminishing.
Staphylococcus aureus is considered the third most important cause of food-borne
diseases in the world (Normanno, 2005). There are two major aggravations to its
presence: the toxins production and antimicrobial resistance. S. aureus produces eatstable
enterotoxins with demonstrated emetic activity (SEs; SEA to SEE, SEG to SEI, SER to
SET). According to the authors, SEs are a main cause of food poisoning that occurs after
ingestion of foods contaminated with S. aureus by improper handling and subsequent
storage at elevated temperatures. Symptoms are of rapid onset and include nausea and
violent vomiting, with or without diarrhea. The illness is usually self-limiting and only
occasionally it is severe enough to warrant hospitalization (Argudn, Mendoza, &

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Rodicio, 2010). The main reservoir of staphylococci in humans is the nostrils,


although staphylococci can also be found on hands. The microorganism is responsible for
enormous variety of infections, such as subcutaneous and skin infections, osteomielites,
pneumonias, abscesses, endocarditic and bacteremia (Gelatti, Bonamigo, Becker, &
dAzevedo, 2009). The prevalence of the bacteria in the population is so high that it is
likely impossible to completely eliminate them. However, hand washing has been
identified as one of the most important ways to prevent the spread of food-borne diseases.
The incidence of foodborne (FbI) infections caused by organisms such as Listeria,
Salmonella, and Escherichia Coli 0157 has declined since 2003. However, the Center for
Disease Control notes that further efforts are needed to sustain these declines and to
improve prevention of food infections. From August 2006 May 2007, 628 cases of
salmonella were attributed to peanut butter produced at a single facility in Georgia (CDC,
2007), while in September 2006 at least 123 people contracted cases of e-coli from
uncooked fresh bagged spinach, resulting in a major product recall. These outbreaks
illustrate the need for continuous employee and consumer education regarding food
safety practices.
Contaminated food and water have been known to be sources of illness in human
societies since antiquity. Foodborne diseases are still among the most widespread health
problems in the contemporary world. In rich and poor countries alike, they pose
substantial health burdens, ranging in severity from mild indisposition to fatal illnesses.
However, the burden of foodborne disease is not well defined globally, regionally or at

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country level (WHO, 2004). Estimates of the burden of foodborne disease are
complicated by the fact that very few illnesses can be definitively linked to food. Often
these links are only made during outbreak situations (Flint, Scott & Bloomfield, 2005).
The ultimate goal for public health and food safety officials is not just stopping
foodborne disease outbreaks once they occur, but preventing them from happening in the
first place. Long-term prevention of foodborne outbreaks takes the actions of many
partners in the food production chain, stretching from farm to table (CDC, 2010)
Dr. Bryan (2004) reviewed the food handling errors that led to foodborne illness
outbreaks reported to the Centers for Disease Control (CDC) between 2001 and 2002 and
divided them into the following categories: failure to properly cool food, failure to
thoroughly heat or cook food, infected employees who practice poor personal hygiene at
home and at the workplace, foods prepared a day or more before they are served, raw,
contaminated ingredients incorporated into foods that receive no further cooking, foods
allowed to remain at bacteria-incubation temperatures, failure to reheat cooked foods to
temperatures that kill bacteria, cross-contamination of cooked foods with raw foods, or
by employees who mishandle foods, or through improperly cleaned equipment. The
factors listed above can be divided into the following broad categories: contaminated
ingredients, temperature control, personal hygiene, cross contamination, and sanitation.
In a recent review of foodborne illness outbreaks in foodservice (Greig, Todd &
Bartleson, 2007) an international group of food safety researchers reported 816 outbreaks
linked to food handler practices, resulting in 80,682 cases of foodborne illness. In the

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review, nearly 60% of food handler-related outbreaks were due to two specific
pathogens often liked to hygiene issues: norovirus and Salmonella. Despite the
investment and focus on training, researchers suggest that the impact of food handler
training programs is inconsistent and program evaluation is rarely conducted. Ideally,
food safety in foodservice establishments begins with managers who are knowledgeable
about the following: where contaminants exist, how they transfer to food, the steps to
control or eliminate hazards.
In a 2007 study (Pragle, Harding & Mack, 2007), researchers at Oregon State
University explored factors that prevented food handlers from practicing good personal
hygiene. Through focus groups, participants reported time pressures; inadequate facilities
and supplies; lack of accountability; lack of involvement of managers and coworkers; and
organizations not supportive of food safety as barriers to employing good personal
hygiene.
The U.S. Centers for Disease Control has been recently calling on food safety
communicators to design new materials aimed at increasing food safety risk reduction
practices from farm-to-fork. This priority was echoed at the Food Safety Inspection
Service/NSF food safety education conference in March 2010: new messages and media
are needed as the traditional communication tools arent getting the job done.
Ignorance, carelessness, and indifference on the part of food handlers result in
insanitary conditions. Poor practices may be found even in establishments where
considerable investment has been made in modern equipment. All food handlers should

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be educated in proper methods through demonstrations, discussions, posters and


pictures.
Assistance and advice may be obtained from local health departments which in
many areas conduct periodic food-handler training courses. A sanitarian can often
achieve more a well-directed educational program that he can by inspection. Food
handlers should wear clean uniforms and keep their hands clean (Assoc. of Food Industry
Sanitarians, 2004).
Food safety is becoming a vital requirement of the hospitality industry. As the
dollar amount spent by consumers on food away from home has increased, so too has the
extent to which food products from the industry impact the health and well being of the
nation. Many factors are shaping the industrys future: international and multinational;
influences, globalization, increasing expectations, as well as, changing patterns of leisure
(Manzano, 2013)
Food safety is a critical issue facing the foodservice industry. An understanding of
food safety procedures and potential factors that cause foodborne illness is very important
for all food handlers. Cohen, Reichel, and Schwartz (2007) stated only knowledgeable,
motivated, and skilled employees who are trained to follow the proper procedures
together with management that effectively monitors employees performances can ensure
food safety. Foodservice workers play a major role in prevention and control of
outbreaks of foodborne illness.

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As the complexity of the food system grows, new safety challenges arise.
Along with the variety of food products may come a variety of biological, chemical and
physical hazards. Because of this, food production, distribution and preparation have
come under intense scrutiny from government agencies, from consumers and from the
industry itself (Berkoff, Allard, Arcand, Brazel, Joliffe & Choleva, 2008).
Providing safe food begins during the hiring process (FDA, 2004). Studies show
that many cases of foodborne illnesses can be linked directly to the lack of attention to
personal hygiene, cleanliness, and food handling procedures. The Center for
Communicable Disease issued a list of infectious and communicable diseases that are
often transmitted through food prepared by infected food handlers. Examples of
biological agents that cause these diseases are Hepatitis A virus, Salmonella typhi and
Norwalk-like viruses.
The presence of hair in food indicates unhygienic food preparation. Food handlers
must wear a hair restraint at all times to prevent hair from falling into the food. Common
hair restraints include nets, bonnets, and caps. Wearing a hair restraint also eliminates the
contact of the hands with the head, thereby preventing contamination such as: a hair
restraint must be worn before hand washing and working and a hair restraint must be
properly worn and should not let a single strand of hair show.
Work clothes that include a kitchen uniform and an apron must be worn inside the
kitchen. Street clothes should never be worn to work as they may be sources of
contamination. Apron helps reduce the transfer of microbes to exposed food.

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Because footwear can serve as a source of contamination, it is necessary to use


footwear exclusively for kitchen use. Footwear worn outside should not be worn in the
food preparation area to prevent the possibility of contamination.
Facial masks prevent airborne microorganisms from the nose and mouth from
getting into the food when talking, coughing or sneezing. These masks will also prevent
direct contact of the hands with the nose and mouth, both of which are sources of
contamination.
Gloves act as barriers between the hands and food. However, these must not be
made substitutes for proper hand washing.
The single most important practice in preventing the spread of foodborne illness is
proper and frequent hand washing. Since person-to-person contamination can play a
significant role in the spread of some enteric pathogens, hand hygiene is a critical
element in any outbreak prevention and control strategy.
Diseases can spread through fecal-oral transmission. Infections which may be
transmitted through this route include salmonellosis, shigellosis, hepatitis A, giardiasis,
enterovirus, amoebiasis and campylobacterosis Because these diseases can spread
through the ingestion of even the tiniest particles of fecal material, hand washing after
using the toilet cannot be overemphasized.
Diseases also spread through indirect contact with respiratory secretions.
Microorganisms which may be transmitted through this route include influenza,
streptococcus, respiratory syncytial virus (RSV), and the common cold. These diseases

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may be spread indirectly by hands freshly soiled by respiratory discharges.
These can be avoided by washing the hands after coughing or sneezing and after shaking
hands with an individual who has been coughing or sneezing.
Diseases may also be acquired when hands are contaminated with urine, saliva or
other moist body fluids. Microorganisms which may be transmitted by these body
substances include cytomegalovirus, staphylococcal organisms, and the Epstein-barr
virus. These germs may be transmitted from person-to-person or indirectly by the
contamination of food or inanimate objects such as toys.
As explained by McSwane, Rue, Linton, & Williams (2004), controlling
temperature of food cooked is vital in assuring that food service establishment complies
with food safety regulations. Food borne illness may be resulted from temperature abuse
while preparing a dish. Time temperature abuse occurs when food has been allowed to
stand for an extended period of time at temperatures favorable to bacterial growth.
Mcswane et al further added that the abuse of temperature also may be caused by
insufficient amount of cooking or reheating time and desired temperatures that should
eliminate the existence of harmful microorganism. The usage of devices in measuring
food temperature such as thermometers, thermocouples and infrared reading is essential
in determining whether the fod were in the danger zone or otherwise (McSwane et al.,
2004). Nott and Hall (2003) explained that the major purpose of cooking is to increase
the palatability of food, the heating of many foods is essential to kill bacteria thereby
increasing the foodstuffs safety and storage life. In practice, pasteurization and other

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sterilization processes require stringent assurance that all parts of the food
product have been heated above a certain temperature for a defined period of time (Nott
and Hall, 2003). Several studies have reported that poor holding and cooking
temperature control was a main factor contributing to food borne outbreaks (Todd, 1997).
Improper holding temperature of food can also contribute to the growth of certain
bacteria through its spores because not all of these spores will be destroyed with heating
processes (McSwane et al., 2004). Thus it is important for all food handlers to recognize
their responsibilities in ensuring that all food prepared were monitored in every stage of
its preparation.
Potentially Hazardous Food (PHF) is any food capable of allowing germs to grow
rapidly (Wiley, 2007). PHFs have the potential to cause food borne illness outbreaks.
They are usually moist, have lots of protein and dont have very high or very low acidity
(neutral acidity). Adding lemon juice or vinegar to foods slows the growth of the germs.
Potentially hazardous foods requires strict time and temperature controls to stay safe.
Food has been time/temperature abused anytime it has been in the temperature danger
zone (41oF to 135oF or 5oC to 57.2oC) for too long. Potentially hazardous foods must be
checked often to make sure that they stay safe. The caution sign includes a clock and
thermometer to stress the importance of monitoring time and temperature. The clock is
the reminder to check food at regular time intervals. The thermometer required must be
properly calibrated, cleaned and sanitized.

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The hands of food service food handlers can be vectors in the spread of
food-borne disease, mainly because of poor personal hygiene and cross-contamination
(Ehiri and Morris, 2006). It was reported in 2009 by Guzewich and Ross that in 89 % of
outbreaks caused by food contaminated by food handlers, pathogens were transferred by
workers hands. More recently, Strohbehn, Sneed, Peaz, & Meyer (2008) found in two
US Food and Drug Administration studies (FDA), that inadequate hand washing practices
by workers occurred in all types of retail food services. Inadequate hand washing was
found to be a contributory factor in 31 % of outbreaks occurring in Washington State
from 1990 to 1999 (Todd et al., 2009).
Proper hand washing was defined by the FDA Food Code for retail
establishments (2007) as an activity lasting for at least 20 seconds involving the use of
warm running water, soap, friction for 10 to 15 seconds, rinsing and drying with clean
towels or hot air. This procedure is described slightly differently in other sources and
may include a single or double wash process, depending on the activity prior to hand
washing (Sprenger, 2008). A single wash would involve using friction and soap only
while the double wash would require the use of a nail brush before re-washing with
friction. Strobehn et al. (2008) found that the correct procedure for hand washing was not
used consistently and rates of compliance ranged between 0 % and 100 %, even in frail
care and child care facilities. In another study, hand washing was reported as more likely
to occur in restaurants where workers had food safety training (Green, Selman, Baneijee,
Marcus, Medus, & Angelo, 2006). It has also been found that the hand hygiene practices

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of workers with more work experience (>10 years) was superior to


inexperienced individuals and concluded that even workers with higher educational levels
would still require specific training on food and personal hygiene (Aycicek, Aydogan,
Kucukkaraaslan, Baysallar, & Basustaoglu, 2004). In a study by Walker, Protenard, &
Forsythe (2003) UK food handlers were interviewed and 94 to 97 % identified the need
to wash their hands after using the toilet, to wear protective clothing, to cover cuts with
easily detectable plasters and that jewellery should not be worn in the kitchen as it can be
contaminated by dirt and bacteria. However, in Turkey only 21.2 % of Turkish food
handlers identified the need to wash their hands after using the toilet, handling raw foods
and before handling RTE food (Bas, Ersane, & Kavane, 2006).
Foodborne disease from biological contamination can happen at any time during
the food preparation process. The processes of cooking, cooling and storage are
particularly susceptible to contamination as preparers are required to prepare, move and
store food. This paper will look at the food cooking, cooling and storing stages within a
restaurant environment and address how some specific bacteria, viruses, and parasites can
thrive and exist at each stage. It will also detail important steps and tools available to
eliminate this threat (McSwane et. al, 2004).
Biological contaminations that can lead to disease are caused primarily by
bacteria, viruses and parasites. During the cooking, cooling or storing stages biological
contamination can be prevented by ensuring proper time and temperatures are used to
prepare the foods and adhering to proper hygiene, cleaning and sanitization procedures.

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Additionally, reducing or eliminating cross contamination will also prevent
contamination. Different bacteria have different temperatures that they need to thrive.
These temperatures can range from as low as freezing to as high as 200 (93.3 C) degrees
Fahrenheit. Most bacteria however thrive in the temperatures close to a human body's
temperature of 98.6 (37 C) degrees Fahrenheit. The food industry often refers to the
temperature range between 41 (5 C) and 135 (57 C) degrees Fahrenheit as the food
temperature danger zone or that range of temperature when most foodborne
microorganisms will rapidly grow. As food moves through the cooking, cooling and
storage stages it must pass through this zone as quickly and safely as possible. Time,
temperature, cleanliness and cross contamination are all key to keeping food safe during
these stages (CDC, 2010).
The Training Manual of National Environmental Health Association (2010) has
indicated that costs associated with preventing foodborne contamination at a restaurant
include providing employees with the proper training, equipment and tools they need to
avoid contamination. Businesses that fail to prevent foodborne disease run the risk of
losing the trust of its customers, jeopardizing its business and preventing it from
remaining competitive. If food is not cooked, cooled, and stored properly, foodborne
disease is not prevented which may lead to loss of reputation or customers. It could
additionally lead to lower profits, fines, lawsuits, and even closure of the business. One
example of one outbreak severely affecting a restaurant due to food contamination
happened in 2003 in Pittsburgh, Pennsylvania. A Chi-Chi restaurant customer contracted

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hepatitis and as a result had to have a liver transplant. The illness was traced
back to the restaurant and the customer received a settlement of $6.25 million. Failure to
meet food safety regulations, legislation and inspections could cause the establishment to
incur additional costs to correct citations. From a fiscal standpoint foodborne disease
costs in the United States are $152 billion per year according to a report from the Pew
Charitable Trust. The World Health Organization reports that in industrialized countries,
the percentage of the population suffering from foodborne diseases each year has been
reported to be up to 30%. Clearly preventing foodborne disease should be an
establishment's highest priority from both a monetary and moral viewpoint.
According to McSwane et. al. (2004), bacteria can survive as a result of
inadequate cooking. They can also multiply with prolonged cooking at low temperatures
and bacterial spores can even survive boiling. Examples of some virulent bacteria that
can be a problem in the cooking stage are Staphylococcus Aureus, Salmonella and
Bacillus Cereus. All can cause nausea, vomiting and cramping and can be avoided by
cooking food according to proper times and temperatures, preventing cross contamination
and using proper hand washing techniques. Symptoms from illnesses caused by these
bacteria starts anywhere from 30 minutes and lasting a day as in the case with Bacillus
Cereus to starting as late as 48 hours after contact and lasting three days as in the case of
the Staphylococcus Aureus bacteria. E. coli 0157:H7 is another trouble causing bacteria
that can cause diarrhea and kidney failure and can be prevented with the use of proper
sanitization methods. E. coli symptoms can show up as late as 72 hours and last for up to

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three days. Viruses, such as Hepatitis A and Norovirus, cause fever, nausea,
vomiting and cramping and can be transmitted during the cooking process by cross
contamination and poor hygiene. Norovirus symptoms appear in approximately 48 hours
and can last two days. Hepatitis A symptoms do not appear until 15 to 50 days after
contact and can last anywhere from several weeks to several months. This long period
before symptom onset makes tracing contamination difficult. Parasites such as Anisakis
spp. and Cyclospora cayentanensis can be transmitted to customers through poor hygiene
and uncooked or under cooked foods and also cause vomiting and diarrhea respectively
(CDC, 2010).
Bacteria & viruses can thrive in dry storage and survive in refrigerated storage.
Bacteria can multiply in refrigerated storage if the temperatures are too high or if foods
are allowed to spoil. Many have the misconception that freezing kills bacteria. In fact
freezing simply keeps bacteria from multiplying. Once food is thawed the bacteria is able
to grow once more. In dry storage bacteria can multiply if food becomes damp. Viruses
such as Hepatitis A can be spread from infected people to produce, salads and ready-toeat foods. Other storage related contamination problems include pests. Pests can carry
bacteria and viruses such as Salmonella, the Poliomyelitis virus and the Hantavirus. As
described previously Hepatitis A symptoms include nausea, vomiting, diarrhea and fever
while Salmonella symptoms include fever, diarrhea and cramps. Hantavirus victims may
feel fatigued, run a fever and experience muscle cramps. The Poliomyelitis virus causes
headache, fever and vomiting (McSwane et al., 2004). Refrigerated foods are stored in a

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variety of different refrigeration storage areas. These can be as simple as a


standalone reach-in refrigerator or a larger walk-in or walk-through refrigeration room.
Different foods require storage at different temperatures. For example, NEHA (2010)
recommends storing fresh meat between 32 (0 C) and 41 (5 C) degrees Fahrenheit at a
humidity level between 85 and 90 percent and fresh poultry between 30 (-1.1 C) and 36
(2 C) degrees Fahrenheit at a humidity level between 75 and 86 percent. The refrigeration
unit's environment should be checked for the proper temperature whenever it is used.
This can be achieved by manually checking the unit's internal thermometer or
automatically accomplished with wide area temperature monitoring and alarm systems.
The actual food temperatures should be checked at the beginning of the day and the end
of the day and whenever there is a temperature fluctuation within the refrigeration unit.
This can be accomplished by performing spot checks using either probe or infrared
thermometers. Monitoring both ambient and food temperatures is necessary from a safety
perspective and keeping accurate records of these temperatures is vital for restaurants to
comply with federal, state and local regulations as well as documenting compliance for
their own safety procedures.
Freezers keep frozen food at 0 (-17.7 C) degrees Fahrenheit or below. At this
temperature foods can have a much longer shelf life. Fresh meat for example stored at 0
(-17.7 C) degrees Fahrenheit can last several months. The freezer temperature should be
checked daily and should be defrosted regularly if it is not a frost free unit. Temperature
controls and equipment such as wireless temperature monitoring systems or data loggers

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should be used to verify consistent temperature ranges.


Dry storage is used for items not requiring refrigeration such as foods packaged in
cans, bottles and bags. NEHA (2010) recommends that the dry storage area should
ideally be maintained at a temperature between 50 (10 C) and 70 (21 C) degrees
Fahrenheit at a humidity level of 50 to 60 percent. This will ensure that the food shelf life
is maximized. Thermometers, temperature control systems or wireless temperature
monitoring systems are used for maintaining and recording consistent temperatures.
These tools should be monitored on a regular basis.
An often deadly misconception is that food is done and safe to eat when it turns
brown. In fact according to the USDA one out of every four hamburgers turns brown
before its internal temperature has reached its safe temperature. Different foods require
different minimum internal temperatures to be determined safe but typically they range
from 140 (60 C) to 165 (73.9 C) degrees Fahrenheit. In addition to reaching this
temperature the product must be held at that temperature for a set period of time. As an
example the USDA lists eggs as requiring an internal temperature of 145 (62.8 C)
degrees Fahrenheit maintained for 15 seconds whereas a thicker pork roast they state
requires a temperature of 145 (62.8) degrees Fahrenheit maintained for three minutes
(USDA, 2009).
Consumers doubting the need for using temperature as a gauge should consider
one CDC report that stated in 2007 one foodborne outbreak resulted in seven food
poisoning victims in Long Island, New York and county health officials believed that all

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contracted the E.coli bacteria from under cooking hamburger meat. One of the
victim's kidneys shut down as a result of the infection. Another report stated that in 1993
there were over 500 confirmed illnesses with four deaths from an E.coli outbreak
associated from eating undercooked hamburgers from just one restaurant chain. The only
safe method to determine if a food is cooked is to take its internal temperature with an
accurate thermometer. Accurate probe and bi-metal thermometers are effective tools to
prevent undercooking (WHO, 2004).
HACCP is an internationally recognized food safety assurance system that
concentrates prevention strategies on known hazards; it focuses on process control, and
the steps within that, rather than structure and layout of premises. HACCP establishes
procedures whereby these hazards can be reduced or eliminated and requires
documentation and verification of these control procedures. Whilst HACCP has been
widely adopted by the food manufacturing industry and the larger companies in the
hospitality and catering sector, there have been concerns about implementation by
smaller businesses. Barriers to the implementation of HACCP in small businesses have
been identified which include lack of expertise, absence of legal requirements, fnancial
constraints and attitudes (WHO, 2009).
According the the Center for Disease Control and Prevention (2010), poor
hygiene has also been linked to outbreaks of foodborne disease. The Center for Science
in the Public Interest or CSPI reported that one Salmonella outbreak at one quick service
restaurant sickened thirty-eight people and may have killed one. The cause was

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determined to be linked to employees not washing their hands before handling


food. According to the CDC and industry experts, 70 to 80 % of foodborne illnesses are
caused by improper hand washing. Many people have the misconception that washing
their hands a couple times per day is sufficient in preventing transmission of bacteria
when in fact hand washing should take place anytime before, between and after touching
raw food and after touching any part of a person's body or cleaning. Equipment and
utensils must likewise be cleaned and sanitized. Further support for the value of personal
and equipment cleanliness comes from the FDA that reports that a virus, such as the
human influenza virus, can survive on surfaces for up to eight hours. Management must
ensure that employees are familiar with the proper methods of cleaning and sanitizing
equipment and utensils.
Despite training, it has also been found that food service workers commonly
reported risky food handling practices (Green et al., 2005). A quarter of the workers were
of the opinion that that they did not always wash their hands while a third did not always
change gloves between touching raw meat or poultry and RTE food. A number of studies
indicate that although training may bring about an increased knowledge of food safety, it
does not always result in a positive change in food handling behavior. However, hand
washing knowledge and behaviour has been reported to improve significantly after
training (Roberts, Barret, & Sneed, 2005).
Food service establishments (FSE) such as restaurants, hotels, bars, and cafeterias
are considered an important source of foodborne outbreaks as studied in various

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European countries (Hughes, Gillespie, & O Brien, 2007).


There are several studies that have discussed that the main causes of microbial
contamination typically occurring in foodservice establishments are contaminated
supplies, dirty food contact surfaces, poor personnel hygiene practices, inappropriate
storage temperatures, and insufficient cooking (Kferstein, 2003; Griffith & Clayton,
2005; WHO, 2007; EFSA, 2007; Jones, Parry, O Brien, & Palmer, 2008).
Food safety depends on good standards of hygiene applied at all stages of the food
production process. Many such rules are enforced by legislation. Food safety also
depends on the industry identifying and controlling risks by regular risk assessment. Risk
assessment is the process of working out how big a risk is, i.e. how likely it is that
someone may be harmed or something may be damaged. One method of doing this is
called Hazard Analysis and Critical Control Points (HACCP). HACCP requires the food
manufacturer or producer to look at every stage of production and identify any hazards
(mainly the growth of food poisoning bacteria, but also the amount of product in a pack,
packaging faults and foreign bodies falling into food. Steps should be taken to prevent
remove or reduce the hazards. Once the hazards are under control, they should be closely
monitored to make sure that everyone involved in production is carrying out hazard
control procedures (Knowles, 2003).
According to Stellman and Mager, (2008) the increasing separation of the
consumer from the food production sector that has accompanied urbanization globally
has resulted in a loss of the traditional means used by the consumer to ensure the quality

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and safety of food, making the consumer dependent on a functional and


responsible food processing-industry. Increased dependence on food processing has
created the possibility of exposure to pathogen-contaminated food from a single
production facility. To provide protection from this threat, extensive regulatory structures
have been established, especially in the industrialized countries to protect public health
and to regulate the use of additives and other chemicals. Harmonization of regulations
and standards across borders is emerging as an issue to ensure the free flow of food
among all the worlds countries.
The Association of Food Industry Sanitarians (2004) indicated that ignorance,
carelessness and indifference on the part of food handlers result in unsanitary conditions.
Poor practices may be found even in establishments where considerable investment has
been made in modern equipment. All food handlers should be educated in proper
methods through demonstrations, discussions, posters and pictures. Assistance and advice
may be obtained from local health departments which in many areas conduct periodic
food-handler training courses. A sanitarian can often achieve more by a well-directed
educational program that he can by inspection. Food handlers should wear clean uniforms
and keep their hands clean.
In the book of Berkoff (2008), she pointed out that as the complexity of the food
system grows, new safety challenges arise. Along with the variety of food products may
come a variety of biological, chemical and physical hazards. Because of this, food
production, distribution and preparation have come under intense scrutiny from

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government agencies, from consumers and from the industry itself.


According to Tull (2004), in the food industry, there are health and safety hazards
at each stage throughout production, retail, preparation and consumption of every
product. Responsibility for ensuring high standards of health and safety at each stage of
the production process rests with every worker, who must be given clear instructions and
training by their manager concerning the use of machinery and tools, the storage of food
products, the control of microorganisms, the use of dangerous chemicals, first aid and
safety procedures. Managers are also responsible for providing their workers with rest
rooms and toilet facilities and must display health and safety notices for both their
workers and the public to read and follow.
According to the FDA Food Code (2009), hands shall be washed in a separate
sink. Automatic hand washing facilities maybe use by food workers to clean their hands.
However, the system must be capable of removing the types of soils encountering in the
food operation. Food employees may not clean their hands in a sink used for preparation
or ware washing, or in a services sink used for the disposal of mop water and liquid
waste.
Perdigon (2005) acknowledged that human beings are the single most common
source of food contamination. They spread bacteria and other microorganisms by unclean
hands. Skin infections are well as by coughing and sneezing. Dirty people are most
dangerous because they can carry the natural contamination found in clean and healthy
people.

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Biological hazards in food include harmful microorganisms like bacteria,


parasites, fungi, viruses and prions (proteinaceous infectious particles) (Ang and
Balanon, 2010). Further emphasized that among the microorganisms bacteria are the
most common food contaminants that cause foodborne diseases. Pathogenic bacteria may
cause foodborne infection or foodborne intoxication. Foodborne infection occurs when a
person consumes low numbers of pathogens together with the food, which then multiply
in the body and invade vital organs. Therefore foodborne intoxication, on the other hand,
is due to the ingestion of toxins, which is produced by bacteria, in food. Staphylococcus
aureus is the most common toxin-producing bacteria. Hazard Analysis Critical Control
Point (HACCP) is an operational system used to select and implement effective control
measures to ensure the safety of a food product. HACCP focuses on potentially
hazardous foods (PHF) and how they are handled. PHF have the ability to support rapid
and progressive growth of infectious and toxin-producing microorganisms. Further
emphasized that in every food establishment has their own set of procedures often simply
described as the way we do things. Many retail and food service establishments have
implemented effective food safety management systems by establishing controls for food
preparation methods and processes common in their operations.
Waggoner (2004) reported that there are thousands of types of bacteria in the
environment, but most of them do not cause harm. For example, there are some types of
bacteria that are beneficial and keep the digestive tract healthy. When harmful bacteria,

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also known as pathogens, enter the food and water supply, they can cause foodborne illness and even death. Spoilage bacteria can cause foods to smell and taste bad.
Moreover, these bacteria can be harmful, but probably will not cause illness. Diseasecausing bacteria are more serious because they usually do not make the food smell or
taste bad, but they can cause illness. Furthermore, the food-borne infections are due to
pathogenic organisms.
Each hand washing sink must be provided with hand cleanser (soap or detergent)
in a dispenser and a suitable hand-drying device. Hand sanitizing lotions and chemical
hand washing/ Proper washing helps to remove visible hand dirt and the microorganisms
it contains. Hand sanitizing lotion must never be used as a replacement for hand washing.
Epidemiological research has indicated that the majority of reported foodborne
illness outbreaks originate in food service establishments and case control studies have
shown that eating meals outside the home is a risk factor for obtaining a foodborne illness
In addition, research on foodborne illness risk factors has indicated that most outbreaks
associated with food service establishments can be attributed to food workers improper
food preparation practices, and observation studies have revealed that food workers
frequently engage in unsafe food preparation practices. These findings indicate that
improvement of restaurant workers food preparation practices is needed to reduce the
incidence of foodborne illness. Food worker intervention programs are needed to effect
this improvement. However, health researchers have argued that an understanding of
current practices and factors affecting those practices is necessary before behavior change

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efforts can be successful (Green et al., 2005).


Food safety in retail foodservice is increasingly important to consumers. Trends
that impact food safety concerns include the increasing number of meals eaten away from
home, increasing consumer awareness about food safety, an aging population, changes in
the foodservice workforce, changing technology in work environments, changes in food
procurement, foodservice risk factors, and food defense concerns. Each of these trends
has implications for dietetics practice, both in working with consumers and managing
foodservice operations (Sneed & Strohnehn, 2008)
Allan Liddle (2004) stated that the seeds of consumer and employee lawsuits lie
everywhere for restaurant operators and seem easily germinated. The good news, some
operators, is that many, if not most, lawsuits can be prevented through management
practices that pay the additional dividends of lower insurance rates, increased
productivity and enhanced loyalty from customers and workers. Attorneys and
foodservice professionals indicate that an appropriate anti-litigation strategy for modern
times calls for detailed hiring and firing guidelines, pre-employment screening to weed
out potentially violent or otherwise undesirable job candidates, regularly updated and
widely posted policies against discrimination or harassment of any kind, awareness of,
and adherence to, prevailing wage-and-hour laws, the maintenance of safe work and
public areas and ongoing worker education related to safely preparing and handling food.
A number of independent and chain operators augment those basics with a wide array of
additional practices that may be considered litigation limiters. For example. Brueggers

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Bagel Bakeries recently contracted with sanitation experts to help establish high
standards and audit company and franchised units for compliance (Nations Restaurant
News, 2005).
Food safety and sanitation is an important public health concern. In the United
States, it is estimated that 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths
are attributed to foodborne illness each year. The annual cost of foodborne illness is
estimated to be from $10 to $83 billion. For some individuals, foodborne illness may
result in a mild, temporary discomfort. Because older adults are a highly susceptible
population, foodborne illness may have serious or long-term consequences, and may be
life threatening. Older adults are vulnerable to foodborne illness for several reasons.
They have weakened immune systems. As part of the aging process, the ability of their
immune system to function at normal levels decreases. A decrease in the level of diseasefighting cells is a significant factor in making the average older adult highly susceptible
to harmful microorganisms in food. They have inflammation of the stomach lining and a
decrease in stomach acid: The stomach plays an important role in limiting the number of
bacteria that enter the small intestine. During the natural aging process, an older persons
stomach tends to produce less acid. The decrease or loss of stomach acidity increases the
likelihood of infection if a pathogen is ingested with food or water. Their sense of smell
and taste declined. Many contaminated foods do not smell or taste bad. However, for
foods like spoiled milk, a person who does not notice "off" odors and flavors is more
likely to eat the food and more likely to become ill. Older people are living on their own.

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For an older person, preparing meals may pose special challenges. A widower
who has not cooked for himself may not know how to prepare food safely. A person
receiving home-delivered meals may not be familiar with safe handling and storage
practices for meals and leftovers (Mead, et al., 2005)
The causes of foodborne illness are multifaceted. Some major risk factors of
foodborne illness are related to employee behaviors and preparation practices in food
service establishments. The principle known risk factors include: Improper holding
temperatures, Inadequate cooking, such as undercooking raw shell eggs, Contaminated
equipment, Food from unsafe sources, Poor personal hygiene, and others such as, pest
and rodent infestation and improper food storage (FDA,2003).
In the study of Green (2005) .A few workers reported unsafe hand hygiene
practices, such as not washing their hands when changing gloves and using sanitizers
instead of washing their hands. Several workers said they sanitized but did not wash and
rinse their equipment after working with raw meat and did not check the temperature of
all the meat they cooked because they believed they could determine food doneness
through other methods (e.g., appearance and feel of the food). Others said they did not
check the temperature of food being reheated or cooled. Most workers, however, reported
safe food preparation practices. For example, workers described a variety of situtions in
which they washed their hands and changed their gloves, and said they cleaned their
work surfaces and equip-ment after preparing raw meat or poultry and checked the
temperatures of held food. These findings indicate that the participants were aware of and

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engaged in multiple food safety practices.


Previous research, however, suggests that food workers (and consumers) report
engaging in food safety practices more frequently than they actually engage in those
practices This phenomenon is likely the result of the social desirability bias, which is the
tendency for people to report greater levels of so-cially desirable behavior (such as safe
food preparation practices) than they actually engage in, or to report their best behavior
rather than their typical or worst behavior. Although it is not possible to determine the
extent to which our participants over-reported their safe food preparation practices, it is
likely that they do not engage in these practices as frequently as they have reported.
Food safety and sanitation regulations. The increasing separation of the
consumer from the food production sector that has accompanied urbanization globally
has resulted in a loss of the traditional means used by the consumer to ensure the quality
and safety of food, making the consumer dependent on a functional and responsible foodprocessing industry. Increased dependence on food processing has created the possibility
of exposure to pathogen-contaminated food from a single production facility. To provide
protection from this threat, extensive regulatory structures have been established,
especially in the industrialized countries to protect public health and to regulate the use of
additives and other chemicals. Harmonization of regulations and standards across borders
is emerging as an issue to ensure the free flow of food among all the worlds countries
(Stellman et al. 2008).

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Gary Trainor (2012) emphasized that business and corporate


management compliance refers to the company obeying all the legal laws and regulations
in regards to how they manage the business, their staff, and their treatment towards their
consumers. Therefore, the concept of compliance is to make sure that corporations will
act responsibly.
Although food premises are regularly inspected, little information is available on
the effect of inspections on compliance records, particularly with respect to the impact of
the frequency of inspection on compliance. High-risk food inspection premises were
randomly assigned three, four or five inspections per year. Results indicated that no
statistical difference existed in outcome measures based on frequency inspection. When
premises were grouped based on the average time between inspections, premises with
greater time between inspections scored better compliance measures relative to premises
that were inspected more frequently. The study was also unique for the level of
consultation and collaboration sought from the public health inspectors (PHIs) assigned
to the Food Safety Program. Their knowledge and experience with respect to the critical
variables associated with compliance were a complementary component to the literature
review conducted by the research team (Journal of Environmental Health, 2008).
Grading systems for retail food facilities have become a heated topic of debate
among health professionals. Perceptions may vary with the individual players, which
Owen (2000) emphasized that the underlying purpose of a grading system can range from
enhancing legal compliance to establishing incentives for organizational change, to

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communicating risks with the public. He further stresses that whether the trigger
event for a grading policy is local news coverage of food safety issues or a deliberate
vision of policy makers, the effectiveness of the system should be evaluated through a
policy analysis that seeks to understand individual perceptions and the underlying
purpose of a grading system. Therefore, the reliability and interpretation of risk
communication is not a shared value among all the players. The effectiveness of a
program could be undermined. However, the current controversy presents opportunities
as well as challenges (Journal of Environmental Health, 2008)
Labensky and Hause (2007) stresses that although local health department
regularly inspect all food service facilities, continual self-inspection and control are
essential for maintaining sanitary conditions. Therefore, one way to ensure compliance is
to frequently check and record the temperature of Potentially Hazardous Foods (PHF)
during cooking, cooling and holding. Maintaining written time and temperature logs
allow management to evaluate and adjust procedures as necessary. Furthermore,
whatever system is followed, all personnel must be constantly aware of and responsive to
risks and problems associated with the safety of the food they serve.
Food safety act of 2013. With the signing into law on August 23, 2013 of the
Republic Act (RA) 10611 otherwise known as the Food Safety Act of 2013 by H. E.
Benigno S. Aquino III, President of the Republic of the Philippines, the food safety
regulatory system in the country including the Good Manufacturing Practices (GMP) and

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the Hazard Analyses at Critical Control Points (HACCP) audits shall be


strengthened (http://nmis.gov.ph/ date accessed October 9, 2013).
Food safety attitude. Attitude is a psychological tendency that is expressed by
the degree to which a person has a favorable or unfavorable evaluation or appraisal of the
behavior in question (Ajzen, 1991).
The attribution theory (Weiner, 1974), specifically the dispositional attribution
which is a tendency to attribute peoples behaviors to their dispositions; that is, to their
personality, character, and ability. In the study, the fast food restaurants food handlers
disposition is their attitude, which is positive or negative towards food safety and
sanitation.
Theory of planned behavior (Ajzen, 1991), in psychology, is a theory about the
link between beliefs and behavior. The concept was proposed by Icek Ajzen to improve
on the predictive power of the theory of reasoned action by including perceived
behavioural control. It is one of the most predictive persuasion theories. It has been
applied to studies of the relations among beliefs, attitudes, behavioral intentions and
behaviors in various fields such as advertising, public relations, advertising campaigns
and healthcare. The theory states that attitude toward behavior, subjective norms, and
perceived behavioral control, together shape an individual's behavioral intentions and
behaviors.
One way to explore behavioral intention and the cognitive beliefs underlying the
formation of intention is through the use of the theory of planned behavior (TpB). The

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TpB states that behavior intention is based on a persons attitude (ones


evaluation of the behavior), subjective norm (ones perception that those who are
important to the person think he or she should or should not perform the behavior), and
perceived behavioral control (ones ability to perform a behavior or barriers which would
prevent one from performing a behavior) (Ajzen and Fishbein, 1991).
According to Ajzens (1991), in the theory of planned behavior, attitude relates to
ones own personal views about a behavior. Attitude may also be defined as positive or
negative views of an attitude object i.e. a person, behavior or event. Theoretically,
Ajzen (1991) have indicated that attitude is a partial indication of behavior. Attitude
towards an event, object, function or person may be favourable or unfavourable.
According to Ajzen (1991), an individual evaluates an event or object positively or
negatively and positive and negative evaluation is the main dominant characteristic of an
individuals attitude.
Attitude and manager perceptions about food safety programs have been well
researched and it has been found that managers attitudes impact the success of food
safety programs and decreasing the number of foodborne illness outbreaks (Howes et.al.,
2005).
In a study of 36 restaurants that received favorable scores on their previous
inspection, restaurant managers who had a favorable attitude about food safety were
likely to score higher on inspection reports than those who did not have a favorable
attitude. They also found that only 23% of the restaurants surveyed had a manager or

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employee certified in food safety. Of the 36 restaurants surveyed that received


favorable scores, 44% had an employee certified in food safety (Roberts, 2003).
If a person holds a negative attitude about a behavior, he or she will be less likely
to partake in the behavior compared to one who has a positive attitude about the behavior.
Attitude was also found to be a significant predictor of behavioral intention. Obviously, if
a manager has positive attitudes about food safety, they will more likely initiate the
behavior (Roberts, 2005).
The responsibility of having positive attitude towards food safety does not only lie
on the shoulder of the management team. Students and even food handlers should take
their own initiatives to enhance their knowledge in the matter and profiling themselves to
be more positive. Pilling, Brannon, Roberts, Shanklin and Howells (2008) found that
food handlers perceive many barriers to implementing food safety programs. Food
handlers noted that lack of time, training and resources, along with employee attitude,
availability of hand sinks, and inconveniently located resources were barriers to hand
washing within a foodservice operation (Pilling et al., 2008). It is undeniable that not all
of teaching institutions in the developing countries which involved in the culinary field is
equipped with the proper and more manageable facilities. It is well known that improving
knowledge does not necessarily lead to changes in attitude or behavior (Ajzen &
Fishbein, 1980). However, the gap between knowledge and behavior is regarded as an
affective dimension. Various studies have shown that the efficacy of training in terms of

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changing behavior and attitudes to food safety is questionable (Mortlock, Peters,


& Griffith, 2003).
Besides knowledge, attitude is also an important factor that ensures a reduction
trend of foodborne diseases. Howes, McEwen, Griffiths & Hanis (2006) indicate the
correlation of positive behaviour, attitudes and continued education of food handlers
towards the maintenance of safe food handling practices. On the other hand, Bas et al.
(2004) in their study found that the attitude scores of the food handlers toward foodborne
diseases prevention and control was poor (44.2 13.2) as well as safety practice scores
were very low (48.4 8.8). According to Howes et al., a study in the USA showed that
approximately 97.0% of foodborne outbreaks were due to improper food handling
practices in food service fields. Previous reports indicate that besides poor hand and
surface hygiene, lack in personal hygiene amongst food handlers was also one of the
most commonly reported practices that gave rise to foodborne illness (Collins, 2006).
This shows that if food handlers take serious note on the cleanliness of their hand, body
and clothing, this will help in preventing incidence of cross-contamination from
occurring (Sneed et al. 2004).
Fast food restaurants. Researchers defined fast-food restaurants as chain
restaurants that have two or more of the following characteristics: expedited food service,
takeout business, limited or no wait staff, and payment tendered prior to receiving food
(Block, 2004).

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A fast food restaurant also known as quick service restaurant responds to


the universal desire for inexpensive and reliable fare that is freshly prepared, portable and
ready on demand. People were finding ways to escape the dinner table long before the 4th
Earl of Sandwich wrapped dried meat in bread c. 1762 so as not to interrupt his work or
his gambling. Cornish pasties and their descendants go back at least as far as the 13th
century; the South Asian samosa is believed to date to the tenth century. In 1867, Charles
Feltman, a German butcher, opened up the first Coney Island hot dog stand in Brooklyn,
New York, though the origin of the term is in dispute (McGinley & Spurr, 2004).
The food intake of the people of any country is related to a number of factors like
income of consumers, employment status, educational level and cultural differences
(Dowler, 2007). Due to global change, the life styles of people change gradually. They
spend more money on fast food rather than spending on higher education, computers,
books, magazines, newspapers, videos, and recorded music (Schlosser, 2008). Fast foods
have been defined by Bender and Bender (2005) as a broad term used for a restricted
menu of food that lend themselves to production techniques. Suppliers tend to specialize
in product such as hamburger, pizza, chicken and sandwiches. Fast food means quick
service -the food already prepared and held, limited menu items and no table service.
The World's Columbian Exposition of 1893 (Chicago) and the St. Louis World's
Fair of 1904 were credited with mass promotion of a number of portable foods, including
the hot dog, the ice cream cone and iced tea. The "diner" concept dates back to 1872,
when Walter Scott of Providence, RI outfitted a horse-drawn lunch wagon with a simple

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kitchen so that he could bring hot dinners to workers. As automobiles became


popular and affordable following the First World War, drive-in restaurants were
introduced.
Walter Anderson built the first White Castle in Wichita, KS in 1916, introducing
the limited menu, high volume, low cost, high speed hamburger restaurant. Partnering
with Billy Ingram in 1921, they formed the first hamburger chain. Featuring a grill and a
fryer that was open to customers' viewing, the restaurants were designed to build
confidence in the notion that low cost could coincide with high product quality.
(McGinley & Spurr, 2004). A and W Root Beer took its product out of the soda fountain
and into a roadside stand in 1919 and began franchising its syrup in 1921. Howard
Johnson pioneered the concept of franchising restaurants in the mid-1930's, formally
standardizing menus, signage and advertising. Wichita, KS was the home of another fast
food innovation, the "Valentine Diner", a portable steel sandwich shop introduced by
Arthur Valentine in 1938. Valentines could be purchased with a low down payment and
financed through a lock box into which the owner was to deposit 50 cents daily. Circuit
riders stopped by monthly to collect this fee; deadbeats discovered that their wagons had
been hauled away. Curb service was introduced in the late 1920's and was mobilized in
the 1940's when carhops strapped on roller skates. The term "fast-food" was coined in
1951, the same year the drive-through window and speaker system was introduced to
chain restaurants by Jack-in-the-Box in San Diego, CA (McGinley & Spurr, 2004)..

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In addition to economic and cultural impact, the growth of the fast-food


industry has had significant implications for the health of the country (DeMaria, 2003).
Thus, fast-food restaurants have had a major influence on the incidence of food-borne
infections, workplace injuries, and most importantly from a cardiovascular standpoint,
obesity. The epidemic of obesity affecting the U.S. has been well documented. The
condition affects not only adults, more than half of whom are overweight or obese, but
also children, in over 25% of whom these conditions are found. As of 1999, nearly 50
million adults in the U.S. were obese or super-obese. Although the precise cause of this
epidemic has not been fully defined, it is clear that it cannot be attributed to genetic
changes. Rather, obesity appears to be due to a combination of environmental factors that
includes the consumption of excess calories and the reduction of physical exertion. In this
regard, the fast-food industry has likely contributed to the increased caloric intake of
many Americans. Specifically, the size of portions served at these restaurants has
increased in response to competitive pressures. Thus, Burger King now sells a triple
decker, and the slogan of Little Caesars pizzas is Big, Big. A large Coke at
McDonalds is 32 ounces (310 calories), and Super Size Fries have 610 calories, while a
Double Western Bacon Cheeseburger and Cross Cut Fries at Carls Jr. restaurant contains
73 grams of fat. Given the documented consumption of fast food in our country, the
contribution of this dietary content to obesity is apparent. Moreover, the introduction of
fast food overseas has been accompanied by a similar increase in obesity in those
countries (McGinley & Spurr, 2004).

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Eating away from home is becoming more common, and fast food
restaurant use in particular is growing even more rapidly (Schlosser, 2004). In 1970,
money spent on away-from-home foods represented 25% of total food spending; by
1995, it comprised 40% of total food spending and by 1999 it reached a record 47.5% of
total food spending. It is projected that, by 2010, 53% of the food dollar will be spent
away from home.3 Fast food has been defined as food purchased in self-service or carryout eating places without waiter service. Between 1977 and 1995, the percentage of
meals and snacks eaten at fast food restaurants increased 200%, while other restaurant
use increased 150%. Fast food outlets are especially popular among adolescents. The
average adolescent visits a fast food restaurant twice a week and fast food outlets provide
about one-third of the away-from-home meals consumed by adolescents. As away-fromhome foods represent an ever-larger proportion of total energy intake, their nutrient
profile becomes more important to examine. Away-from-home foods are higher in fat
and energy compared with foods eaten at home. In 1995, away-from-home foods
accounted for 27% of eating occasions, but 34% of energy intake. At-home foods
comprised 31% fat; by contrast, away-from-home foods comprised 38% fat energy.
Although about a quarter of Americans eat fast food every day, with 2001 sales
reaching over $110 billion in the United States alone (Schlosser, 2004), few worry about
the safety of the food. Most consumers operate under the assumption that health
inspectors' visits to fast-food restaurants prevent and correct risks that can arise from
unsafe practices that food handlers are trained to avoid. Yet, little data are available that

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document the extent to which hazardous practices occur. Research in this area
generally focuses on managerial strategies to improve inspection scores, rather than on
everyday behind-the-scenes operations. In fact, consumers possess very limited
knowledge about the practices of employees who actually prepare the food, which details
the observations of a college student with extensive work history in the fast-food industry
(Dundes & Swan, 2008)
In the Wall Street Jourmal, fast food restaurants are taking a new course. In the
hope of appealing to more-sophisticated consumers, fast-food chains are moving beyond
simple cheeseburgers and tacos, adding fancier ingredients such as portabella
mushrooms, citrus-herb marinated chicken and pepper bacon. The move is driven by a
growing foodie culture as well as the success of chains like Chipotle Mexican Grill Inc.
CMG -0.42% and Panera Bread Co. PNRA -1.64% , a category known as "fast casual,"
where customers still order at a counter but are paying for something up a notch from a
burger, fries and a shake. Both Chipotle and Panera did well during the economic
downturn by attracting customers who were trading down from full-service restaurants
but still wanted freshly prepared food at affordable prices. Long criticized for selling prepackaged, frozen and made-in-advance sandwiches, fast-food chains are trying to steer
away from the perception of processed food by emphasizing the freshness of their
products. While fresh ingredients cost more than canned and frozen ones, chains say it is
worth it for brand building, and higher quality gives them more pricing power. Early
signs indicate it is working. Taco Bell, a unit of Yum Brands Inc., YUM +0.29% recently

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introduced a "Cantina Bell" line of Chipotle-like burritos and salad bowls made
with fresh avocados and cilantro dressing. (Jargon, 2012)
People everywhere love to go to restaurants, whether it is fast food, pizza or a
sizzling steak dinner. Restaurants compete for customers every day. They realized that an
adequate staff scheduling is critical to providing the kind of quality customer service that
brings people to the establishment and keeps them coming back (Clavel, 2012).
Restaurant operation depends on its size and various management levels. Restaurants
range from unpretentious lunching or dining places catering to people working nearby,
with simple food served in simple settings at low prices, to expensive establishments
serving refined food and wines in a formal setting. Typically, customers sit at tables, their
orders are taken by a waiter who brings the food when it is ready, and the customers pay
the bill before leaving.
Every establishment according to Stone (2011) should go above and beyond the
norm to ensure that food is properly handled. Customers, before ordering their next meal
at the restaurant, are these days taking a close look at the employees and the environment
if they can. They may not be able to spot what goes on behind the scenes, but they trust
their instincts for what they are able to observe. This is one more reason why it is better
not to understaff. Operators should ensure that the expectations of employees are
reasonable, and they should hold regular training programs. Even taking a few hours out
of a day between meal time to conduct a food safety drill, involving the whole team ,
will go a long way to promoting healthy practices in the kitchen. Dropping in for a spot

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check every now and then will also be effective. To prevent employees from
resenting surprise inspection, must be done to help out for an hour or so during the shift.
Through this, there is an opportunity to set a good example, as well as boost morale by
showing the staff that the boss work beside them as equals.
Attitude and Compliance. Presidential decree 856 Code of Sanitation Section 18
(2007) states that owners, managers, and operators of food service should secure a
sanitary permit from the local health authority before establishing and operating their
business trade. Moreover, Section 19 stipulated that no person should be employed in any
food establishments without health certificate issued by the local health authority.
Individual attitudes towards compliance have been shown to be a function of
social or cultural norms (Naylor, 2009). If such attitudes would carry over to actual
compliance, enhancing these norms, as through increasing overall trust in government, is
a desirable policy instrument to compliment the usual enforcement options.
Askarian, Kabir, Aminbaig, Memish & Jafari (2006) presented findings that
strong associations were found among knowledge, attitude, and practice. Attitude has a
lot of influence on compliance, as shown in the study of Armonio, et al (2002) and
Suchitra and Devi (2007). Such also was the case supported by Askarian, et al (2006), as
it indicated that attitude mediated the relationship between knowledge and compliance.
Pittet (2004) supported this statement and aptly termed it behavior modification. It was
vital, therefore, to find ways to improve attitude in order to improve compliance.

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On the other hand, attitudes vary greatly in how strong they are
(Converse, 1970). Strong attitudes are especially important to understand as they have
greater resistance to change and greater impact on behavior (Krosnik & Petty, 1995).
However, when something substantially affects people, their attitude towards it
are likely to be strong (Crano, 1995). Managers of these businesses must comply with
regulation and deal with inspectors. Therefore we assume that their attitudes towards
them are likely to be strong.
In a study conducted by Kaplowitz & Eyck (2006), The greatest predictor of
managers attitudes towards regulation is how safe they perceive the food supply to be.
The belief that their customers are concerned about safety also indirectly affects this
attitude, but less that their own beliefs. This is surprising, as majority ordinarily think of
business people as having their policies driven primarily by the demands of the market
rather than by their personal preferences and beliefs.
The Report of the FDA Retail Food Program Database of Foodborne Illness Risk
Factors was the Food and Drug Administrations (FDA, 2004) first attempt to develop
baseline data about compliance of retail foodservice operations risk factors for
foodborne illness. Only 60% of full-service and 74% of quick service restaurants were
found to be in compliance with current health code requirements. These are lower
percentages than found in non-commercial foodservice operations, such as hospitals,
nursing homes, and elementary schools.

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A follow-up study by the FDA (2004) found that 13% of full-service
restaurants were out of compliance for purchasing food from unsafe sources, 42.7% for
poor personal hygiene, and 63.8% for improper holding time and temperature. The
percentages of quick service restaurants out of compliance with these risk factors were
lower with 2.3%, 31.2%, and 41.7%, respectively. Because of the relatively high
incidence of restaurants that are out of compliance with risk factors and food safety,
restaurant managers should focus on those behaviors that are known to cause foodborne
illnesses and emphasize them in training.
According to Mohammad (2009) the Foodborne Diseases Active Surveillance
Network (FoodNet) of CDC's Emerging Infections Program collects data from 10
American states regarding diseases caused by pathogens commonly transmitted through
food. In 2005 data, Foodnet sites reported 205 foodborne disease outbreaks to the
national Electronic Foodborne Outbreak Reporting System; 121 (59%) were associated
with restaurants. Etiology was reported for 159 (78%) outbreaks; the most common
etiologies were norovirus (49%) and Salmonella (18%). In 1998, the Food and Drug
Administration (FDA) conducted a study to ascertain the rate at which food handlers
were in compliance with standards established in the food code.
Summary
The review of the related literature aimed at finding support for the present study
on food safety and sanitation: attitude and regulations compliance of fast food
restaurants. It was likewise the purpose of the review to offer a clear investigation of the

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concepts and importance of the key variables in the present investigation by


presenting the different views and findings pertaining thereto.
The first part of the study is in line with the related practices that deal with the
proper way of applying food safety and sanitation and what are the effects of its
negligence.
Food safety has become an issue of special importance for the retail food industry.
There are many opportunities for food to be contaminated between production and
consumption. (Ang & Balanon, 2010). Food safety is especially critical in retail food
establishments because this may be the last opportunity to control or eliminate the
hazards that might contaminate food and cause foodborne illnesses. Even when
purchased from inspected and approved sources, ingredients may be contaminated when
they arrive at the food establishment. It is important to know how to handle these
ingredients safely and how to prepare food in such a manner that reduces the risk of
contaminated food being served to clients or customers.
Most cases of food poisoning happen in foodservice establishments and usually
afflict a great number of people. Commercial food service establishments have been
identified by the Center for Disease Control as the leading source of foodborne illness
outbreaks (Bean et al., 1996). Statistics show that in the Philippines, the second highest
death-related illness is intestinal disease. Outbreak of foodborne illnesses could be
prevented if foodservice workers have proper training, techniques, and tools in food
management.

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The responsibility of having positive attitude towards food safety does


not only lie on the shoulder of the management team. Food handlers should take their
own initiatives to enhance their knowledge in the matter and profiling themselves to be
more positive. Pilling, Brannon, Roberts, Shanklin and Howells (2008) found that food
handlers perceive many barriers to implementing food safety programs. Food handlers
noted that lack of time, training and resources, along with employee attitude, availability
of hand sinks, and inconveniently located resources were barriers to hand washing within
a foodservice operation (Pilling et al., 2008).
Restaurants that cause foodborne illnesses stem from human error. Inspectors
emphasize that it is imperative for workers to wash hands or change gloves before
starting work, and as often as needed during food preparation and serving.
Researchers defined fast-food restaurants as chain restaurants that have two or
more of the following characteristics: expedited food service, takeout business, limited or
no wait staff, and payment tendered prior to receiving food (Block et al., 2004).
A fast food restaurant also known as quick service restaurant responds to the
universal desire for inexpensive and reliable fare that is freshly prepared, portable and
ready on demand.
Individual attitudes towards compliance have been shown to be a function of
social or cultural norms (Naylor, 2009). If such attitudes would carry over to actual
compliance, enhancing these norms, as through increasing overall trust in government, is
a desirable policy instrument to compliment the usual enforcement options.

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Attitude and employee perceptions about food safety and sanitation have
been well researched and it has been found that employees attitudes impact the success
of food safety programs and decrease the number of foodborne illness outbreaks (Howes
et.al., 2005).

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Chapter 3
Research Design and Methodology

This chapter is divided into three parts: (1) Purpose of the Study and Research
Design, (2) Method, and (3) Data Analysis Procedure.
Part One, Purpose of the Study and Research Design, outlines the objectives and
hypotheses of the study and identifies the theories related to food safety and sanitation.
Part Two, Method, introduces the participants and research instruments and
outlines the procedure followed in the conduct of the study.
Part Three, Data Analysis Procedure, provides the statistical tools used to analyze
and interpret the data.
Purpose of the Study and Research Design
This descriptive-correlational research aimed to ascertain the food handlers
attitude towards food safety and sanitation and the fast food restaurants compliance with
safety and sanitation regulations.
The survey-correlational method of research was employed in this investigation.
Fraenkel and Wallen (2003) explained that the major purpose of survey research is to
describe the characteristics of a population. In essence, information is collected from a
group of people in order to describe some aspects or characteristics (such as abilities,
opinion, attitudes and or knowledge) of the population of which the group is part. In
correlation research, sometimes called associative research, the relationships among two

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or more variables are studied without any attempt to influence them. In their
simplest form, correlational studies investigate the possibility of relationships among the
two variables, although in investigations of more than two variables are common.
Method
Participants. The participants of this investigation were the 200 randomly
selected food handlers in fast food restaurants in Iloilo City. The food handlers were
taken as an entire group and classified according to sex, age, educational attainment,
industry experience, and position. The participants were selected through two-stage
sampling. The names of the 59 fast food restaurants in Iloilo City were written on slips of
paper, rolled and placed inside a box. Then the lottery technique was employed, whereby
12 fast food restaurants were drawn and served as basis of where the participants were
chosen.
As shown in Table 1, in terms of sex, 71 or 36% were males, while 129 or 64%
were females. In terms of age, 80 or 40% were below 20 years old, 85 or 41% were
between 20-30 years old, 28 or 14% were 31-40 years old and 10 or 5% were over 40
years old. When grouped according to educational attainment, 41 or 20% were high
school graduates, 153 or 77% were college graduates and 6 or 3% were post-graduates. In
terms of industry experience, 87 or 43% had less than a year of experience, 86 or 44%
had 2-5 years of experience, 17 or 8% had 6-10 years of experience and 10 or 5% had
more than 10 years of experience. When grouped according to job position, 178 or 89%
were line/staff and 22 or 11% were managers.

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Table 1
Distribution of Participants
Category

A. Entire group

200

100

Male
Female

71
129

36
64

C. Age
< 20
20-30
31 and above
40 and above

80
85
28
10

40
41
14
5

D. Educational attainment
High School
College
Post Graduate

41
153
6

20
77
3

E. Industry experience
1 year and less
2-5 years
6-10 years
Over 10 years

87
86
17
10

43
44
8
5

F. Job position
Line/staff
Manager

178
22

89
11

B. Sex

Table 2 shows the categories of restaurants. In terms of number of food handlers,


7 or 58% had less than 30 food handlers while 5 or 42% had over 30 food handlers.
When grouped according to restaurant size, 6 or 50% had less than 40 seating capacity, 4
or 33% had 40-80 seating capacity, while 2 or 17% had more than 80 seating capacity. In

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terms of type of restaurant, 9 or 75% were Chain restaurants, while 3 or 25%


were independent restaurants.
Table 2
Distribution of Fast Food Restaurants
Category

A. Entire group

12

100

B. Number of food handlers


Less than 30
Above 30

7
5

58
42

C. Restaurant size
< 40 seats
40-80 seats
> 80 seats

6
4
2

50
33
17

D. Type of restaurants
Chain
Independent

9
3

75
25

Data-gathering Instrument. To gather data on the level of food handlers


attitude towards food safety and sanitation and the regulations compliance of selected fast
food restaurants, the researcher utilized two (2) data gathering instruments: the Sneed and
Lin (2010) questionnaire on the attitudes of food handlers towards food safety and
sanitation and the Sanitary Inspection of Food Establishment Compliance Form (2012) of
the Iloilo City Health Office.
Attitude towards food safety and sanitation. The Sneed and Lin (2010)
questionnaire on the attitudes of food handlers towards food safety and sanitation

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determined the level of attitude towards food safety and sanitation of food
handlers of the randomly selected fast food restaurants in Iloilo City. The items were
measured using a five-point Likert scale.
To interpret the mean scores obtained, the following scale and interpretation were
used:
Mean Scores

Interpretation

3.01 - 5.00

Positive

1.00 - 3.00

Negative

Regulation Compliance. The Sanitary Inspection of Food Establishment


Compliance Form of the Iloilo City Health Office indicated the items needed by the fast
food restaurants to comply. The perfect score is 100 and non-compliance of an item will
earn a demerit of 5 points.
The following total points were interpreted as follows:
Total Points

Interpretation

90-100

Complied to a high extent

70-89

Complied to a moderate extent

50-69

Complied to a low extent

Below 50

Not complied

Procedure. Prior to the actual data gathering, the researcher secured permission
from the office of the managers of the chosen fast food restaurants to conduct the study.

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After which, the researcher explained to them the purpose and the mechanics of
the study. The data for the compliance of sanitary inspection of food was taken from City
Health Office of Iloilo City.
Data Analysis Procedure
The data gathered for this study were subjected to certain computer-processed
statistics.
Frequency count. Frequency count was used to determine the number of
participants and restaurants belonging to a class or category.
Percentage analysis. To determine which portion of the participants and
restaurants that belong to a class or category of the variables, the percentage analysis was
used.
Mean. The mean score was used to determine the food handlers attitude towards
food safety and sanitation.
Standard deviation. The standard deviation was employed to find out the
homogeneity or heterogeneity of the participants attitude towards food safety and
sanitation and restaurants compliance to regulations.
t-test for Independent samples. The t-test for independent samples set at .05
alpha level was used to determine the significant difference that existed between twolevel categories.
One-way analysis of variance (ANOVA). To find out the significant differences
among three or more categories, the one-way ANOVA was employed.

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Mann-Whitney test. The Mann-Whitney test was used to determine the


significant differences in the level of regulations compliance of fast food restaurants
classified according to number of food handlers and type of restaurant.
Kruskal-Wallis test. To find out the significant difference in the level of
regulations compliance of fast food restaurants classified according to restaurant size, the
Kruskal-Wallis test was employed.
Pearsons product moment of coefficient correlation (Pearsons r). The
Pearsons product moment coefficient of correlation was employed to ascertain the
relationship between the attitude towards food safety and sanitation and compliance to
regulations.
The .05 alpha level was used as the criterion for the acceptance and rejection of
the null hypotheses.

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Chapter 4
Results

Chapter 4 is divided into two parts: (1) Descriptive Data Analysis, and (2)
Inferential Data Analysis.
Part One, Descriptive Data Analysis, reports the descriptive data and their
respective analyses and interpretations.
Part Two, Inferential Data Analysis, presents the inferential data and their
respective analyses and interpretations.
Descriptive Data Analysis
Attitude towards food safety and sanitation of food handlers of fast food
restaurants. Data in Table 3 revealed that, generally, the food handlers had positive
attitude toward food safety and sanitation whether taken as entire group or classified
according to certain categories. This was revealed by the obtained mean scores which fell
within 3.01 5.00 scale.
The obtained deviations which ranged from 0.26 0.49 revealed the narrow
dispersion of the obtained means, indicating homogeneity of the food handlers attitude
towards food safety and sanitation.

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Table 3
Attitude Towards Food Safety and Sanitation Among Food Handlers
in Fast Food Restaurants
Category

Description

SD

4.54

Positive

0.34

Male
Female

4.53
4.55

Positive
Positive

0.33
0.34

Less than 20
21-30
31 and above
40 and above

4.52
4.52
4.60
4.72

Positive
Positive
Positive
Positive

0.31
0.35
0.40
0.26

D. Educational attainment
High school
College
Post graduate

4.47
4.56
4.54

Positive
Positive
Positive

0.36
0.32
0.49

E. Experience
1 year and less
2-5 years
6-10 years
Over 10 years

4.57
4.47
4.58
4.76

Positive
Positive
Positive
Positive

0.29
0.37
0.36
0.26

F. Job Position
Line/staff
Manager

4.53
4.63

Positive
Positive

0.33
0.37

A. Entire group
B. Sex

C. Age

Mean Scores

Interpretation

3.01 5.00

Positive

1.00-3.00

Negative

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Level of food safety and sanitation regulations compliance among
fast food restaurants. Data in Table 4 showed that with the exception of fast food
restaurants with more than 80 seating capacity who had high extent (M = 90.00) of
compliance, the fast food restaurants had complied with food safety and sanitation
regulations to a moderate extent whether taken as an entire group and classified
according to number of food handlers and type of restaurant. These were revealed by the
obtained scores which fell between 79-89 scale.
The obtained standard deviations which ranged from 0.00-5.00 revealed the
narrow dispersion of the means indicating the homogeneity of fast food restaurants in
terms of regulations compliance.

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Table 4
Level of Compliance to Food Safety and Sanitation Regulations among Fast Food
Restaurants
Category

Description

SD

A. Entire group

86.67

Moderate extent

3.26

B. Number of food handlers


Less than 30
More than 30

85.71
88.00

Moderate extent
Moderate extent

3.45
2.74

C. Restaurant size
Less than 40 seating capacity 85.83
40-80
86.25
More than 80 Seating capacity 90.00

Moderate extent
Moderate extent
High extent

3.76
2.50
0.00

D. Type of restaurant
Chain
Independent

Moderate extent
Moderate extent

2.64
5.00

87.22
85.00

Total Points

Interpretation

90-100

High extent

70-89

Moderate extent

50-69

Low extent

Below 50

No compliance

Inferential Data Analysis


Differences in the attitude towards food safety and sanitation among food
handlers of fast food restaurants classified according to categories. The t-test result in

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Table 5 revealed no significant differences in the attitude towards food safety


and sanitation among food handlers of fast food restaurants grouped according to sex
(t (198) - .309, p = .76), and job position. (t (198) 1.341, p = .182).

Table 5
t-test Results for the Difference in the Attitude Towards Food Safety and Sanitation
Among Food Handlers of Fast Food Restaurants when Grouped According to Sex and
Job Position
Category
A. Sex

df

t-value

Sig.(2 tailed)

Male
Female

4.53
4.55

198

0.309

0.76

Line/staff
Manager

4.53
4.63

198

1.341

0.182

E. Position

The one-way Anova in Table 6 revealed that significant differences existed in the
attitude towards food safety and sanitation among food handlers in fast food restaurants
classified according to educational attainment (f (3,196) = 3.56), p = .015), and industry
experience. (f (3,196) = 71.32), p = .00).
No significant difference existed in the attitude towards food safety and sanitation
among food handlers of fast food restaurants classified according to age (f (3,196) = 1.45)
p = .23).

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Table 6
One-way ANOVA Results for the Differences in the Attitude Towards Food Safety and
Sanitation Among Food Handlers of Fast Food Restaurants Classified According to
Educational Attainment, Industry Experience and Age
df
Category
Educational
attainment
Industry
Experience
Age

Sum of squares

Mean square

Between
groups

Within
groups

Total

Between
groups

Within
groups

Total

Between
groups

Within
groups

Sig.

196

199

2.11

38.77

40.88

.70

.20

3.56

0.015

196

199

68.63

62.87

131.50

22.88

.32

71.32

0.00

199

.49

22.22

22.71

0.16

0.11

1.45

0.23

196

High school educated participants (M = 4.47) had significantly lower scores in


terms of their attitude towards food safety and sanitation compared with college educated
(M = 4.56) and post graduate educated (M = 4.54) participants.
Those who had 2-5 years of industry experience (M = 4.48) had lower scores in
terms of their attitude towards food safety and sanitation compared with those who had 1
year and less experience (M = 4.57), those that had 6-10 years of experience, (M = 4.59)
and over 10 years of experience (M = 4.76) respectively.
Difference in the level of food safety and sanitation regulations compliance
among fast food restaurants. The Mann-Whitney test result in Table 8 revealed no
significant difference in then food safety and sanitation regulations compliance among

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fast food restaurants when grouped according to number of food handlers and
type of restaurant. (W = 39.00, p = .24) (W = 15.50, p = .411)

Table 7
Mann-Whitney Test Results for the Differences in the Level of Food Safety and Sanitation
Regulations Compliance Among Fast Food Restaurants in Iloilo City Classified
According to Number of Food Handlers and Type of Restaurant
Category

Mean Rank

Sum of Ranks

Sig.

< 30
> 30

5.57
7.80

39
39

39.00

0.240

Chain
Independent

6.94
5.17

62.50
15.50

15.50

0.411

Number of
food handlers

Type of
restaurant

The Kruskal-Wallis test result in Table 9 revealed no significant difference in the


regulations compliance among fast food restaurants when grouped according to restaurant
size. (H (2) = 2.804, p = .246)

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Table 8
Kruskal-Wallis Test Results for the Differences in the Level of Food Safety and Sanitation
Regulations Compliance Among Fast Food Restaurants in Iloilo City Classified
According to Restaurant Size
Category

Mean rank

6
4
2

5.75
5.88
10.00

Chisquare

df

Sig.

2.804

0.246

Restaurant
Size

< 40
40-80
> 80

Relationship between attitude towards food safety and sanitation of food


handlers and compliance to regulations of fast food restaurants. Data in Table 10
showed that the attitude towards food safety and sanitation of food handlers and the
restaurants compliance were negatively and not significantly related, r = - .157,
p = .626.

Table 9
Relationship between Attitude towards Food Safety and Sanitation of Food Handlers and
Regulations Compliance among Fast Food Restaurants.

Variable
Attitude

r
-.157

Regulations
compliance
p
.626

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Chapter 5
Summary, Conclusions, Implications and Recommendations

This chapter is divided into four parts: (1) Summary of the Problems, Method and
the Findings, (2) Conclusions, (3) Implications, and (4) Recommendations.
Part One, Summary of the Problems, Method, and Findings, presents the
important points of the study and the findings.
Part Two, Conclusions, cites the conclusions drawn from the results of the
investigation.
Part Three, Implications, delineates the relationships between the findings of the
present study and the existing theories related to attitude towards food safety and
sanitation and compliance to regulations.
Part Four, Recommendations, gives recommendations based on the findings,
conclusions, and implications.
Summary of the Problems, Method, and Findings
This study aimed to ascertain the attitude of food handlers towards food safety
and sanitation, and the regulations compliance of fast food restaurants to regulations on
safety and sanitation.
Specifically, the study aimed to answer the following questions:
1. What is the attitude of food handlers of fast food restaurants towards food
safety and sanitation when they are taken as an entire group and classified according to:

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(a) sex, (b) age, (c) educational qualification, (d) industry experience, and (e) job
position?
2. What is the level of compliance to regulations of fast food restaurants taken as
entire group and classified according to: (a) restaurant size, (b) number of food handlers,
and (c) restaurant type?
3. Are there significant differences in the attitude of food handlers of fast food
restaurants towards food safety and sanitation when they are classified according to: (a)
sex, (b) age, (c) educational qualification, (d) industry experience, and (e) job position?
4. Are there significant differences in the level of compliance to regulations of
fast food restaurants classified according to: (a) restaurant size, (b) number of food
handlers, and (c) restaurant type?
5. Is there a significant relationship between the food handlers attitude towards
food safety and sanitation and the fast food restaurants compliance to regulations?
In view of the preceding problems, the following hypotheses are advanced:
1. There are no significant differences in the attitude of food handlers of fast food
restaurants towards food safety and sanitation when they are classified according to: (a)
sex, (b) age, (c) educational qualification, (d) industry experience, and (e) job position.
2. There are no significant differences in the level of compliance to regulations of
fast food restaurants classified according to: (a) restaurant size, (b) number of food
handlers, and (c) restaurant type.

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3. There is no significant relationship between the food handlers attitude


towards food safety and sanitation and fast food restaurants compliance to regulations.
This survey-correlational study, conducted from December to January 2014,
utilized 200 randomly selected food handlers in fast food restaurants in Iloilo City. Twostage random sampling method was used.
Two data-gathering instruments were utilized to obtain the data for the study; the
Sneed and Lin (2010) questionnaire on the attitude towards food safety and sanitation of
food handlers and the Sanitary Inspection of Food Establishment Compliance Form of the
Iloilo City Health Office.
To interpret the obtained data, the researcher employed the frequency, percentage
analysis, mean and standard deviation as descriptive statistics, while the one-way
ANOVA, t-test, Mann-Whitney, Kruskal-Wallis and the Pearsons r, all set at .05
significance level were employed for inferential analysis.
Results of the investigation were as follows:
1. Food handlers of fast food restaurants had positive attitude towards food safety
and sanitation whether taken as an entire group or classified according to certain
categories.
2. With the exception of fast food restaurants with more than 80 seating capacity
that had high extent of compliance, the fast food restaurants had complied with food
safety and sanitation regulations to a moderate extent whether taken as an entire group
and classified according to categories.

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3. The food handlers differed significantly in their attitude toward safety


and sanitation when they were classified according to educational attainment and
experience, but they did not differ significantly when they were classified according to
sex, age and job position.
4. The fast food restaurants did not differ significantly in their level of compliance
to regulations when they were classified according to number of food handlers, restaurant
size, and type of restaurant.
5. Finally, the attitude towards food safety and sanitation of food handlers and
regulations compliance among fast food restaurants were negatively and not significantly
related.
Conclusions
In view of the findings, the following conclusions were drawn:
1. It appears that the food handlers of fast food restaurants are conscious of the
importance of health and sanitation. Their positive attitude towards food safety and
sanitation maybe attributed to their knowledge on the detrimental effects of unsafe food
and non-hygienic practices to the health of their clients.
2. Generally, the fast food restaurants appear to have complied with 14-17
requirements out of 20 enumerated in the Code of Sanitation of the Philippines for
restaurants. The findings seem to indicate that the fast food restaurants still have to
follow more recommended corrective measures required by the City Health Office to
improve their ratings.

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3. Sex, age and job position were factors found not to significantly
influence food handlers attitude towards food safety and sanitation. It may therefore be
construed that regardless of whether one is a male or female; young, mid-adult or older; a
line staff or a manager, ones attitude remains comparable.
Educational attainment and industry experience are factors found to significantly
influence the attitude towards food safety and sanitation. This seems to show that those
who have higher education have more understanding of the importance of providing safe
food. On the other hand, foodhandlers who have worked longer in the industry have
internalized and appreciated the value of food safety and sanitation and its impact in the
industry they work in.
4. Number of food handlers, restaurant size, and type of restaurant were factors
found not to significantly influence the level of regulations compliance of fast food
restaurants. It may therefore be construed that regardless of whether fast food restaurants
have few or many food handlers; have small, medium or big seating capacity; and is a
chain or independent restaurant, the level of regulations compliance remain comparable.
5. Ones attitude towards food safety and sanitation is not a factor that
significantly affect the regulations compliance of fast food restaurants. Therefore, a
positive or a negative attitude does not guarantee adherence to certain food safety and
sanitation regulations.

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Implications
The results of the study have important implications both for theory and practice.
The present investigation found out that food handlers of fast food restaurants have a
positive attitude towards food safety and sanitation. This result is similar with the
findings of the study conducted by Sneed (2004) where food handlers got mean scores
ranging from 4.2 to 4.8 out of 5 points.
Furthermore, Parcel (2003) stressed that a persons behavior is influenced by
his/her beliefs and attitudes. Also, Rahman et al. (2012) found in their study that positive
attitude formation leads to positive behavior. Attitude is an important factor that ensures a
reduction trend of foodborne diseases. Howes et al. (2006) found the correlation among
positive behaviour, attitude and continued education of food handlers towards the
maintenance of safe food handling practices. On the other hand, Bas et al. (2004) in their
study found that the attitude scores of the food handlers toward foodborne diseases
prevention and control was poor and their scores on safety practice were very low.
A positive attitude towards food safety and sanitation of food handlers of fast
food restaurants in Iloilo City provides evidence that the food handlers perceive
positively their responsibility to ensure the safety of their customers. Food handlers are
responsible in maintaining a high standard of personal hygiene, and must be equipped
with proper knowledge, skills, and training in maintaining food safety and sanitation in
the food and beverage they serve (Pescadera, 2013).

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In another theory according to Sandique (2007), a safe working


environment and sanitary atmosphere in food service industry are always important. An
outbreak of an illness can be expensive and can damage the good name and image of an
establishment. There are possible legal costs combined with loss of revenue that may
force an establishment to close.
For practice according to Roldan and Edica (2008), food safety covers certain
practices like prevention of growth and multiplication of bacteria; prevention from food
contamination of bacteria, toxin, and other harmful substances; prevention of food
spoilage; prevention of food poisoning and infection, and spreading of disease; and
retaining nutritional and aesthetic qualities of food. Food safety in a food establishment is
assured when all the conditions of bacterial growth are controlled. This is done through
time and temperature control; proper housekeeping maintenance; proper maintenance of
cooking and serving equipment and facilities; and consistent compliance to standards of
hygiene, sanitation, and food safety. Roldan and Edica stated that the case of food borne
diseases can cause irreparable damage to the reputation of a food establishment. One
single case of food poisoning can already discourage diners from coming back to the
restaurant or canteen.
Unhygienic food handlers can be instruments in transmitting bacterial
contamination and food borne disease. It is, therefore, important for every food handler to
understand and practice the rules of safety in handling and serving food. For example,
when a kitchen or dining area is not properly maintained in terms of cleanliness and

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sanitation, it becomes vulnerable to the growth and multiplication of


microorganisms or bacteria as well as pests (Roldan & Edica, 2008).
In a study of 36 restaurants that received favorable scores on their previous
inspection, restaurant managers who had a favorable attitude about food safety were
likely to score higher on inspection reports than those who did not have a favorable
attitude. They also found that only 23% of the restaurants surveyed had a manager or
employee certified in food safety. Of the 36 restaurants surveyed that received favorable
scores, 44% had an employee certified in food safety (Roberts, 2003). The research study
also revealed that fast food restaurants have a moderate level of regulations compliance.
Because of this, the risk factors and incidences attributed to food safety and sanitation in
these establishments is in a downward trend.
In the study conducted by the FDA (2004) only 60% of full-service and 74% of
quick service restaurants were found to be in compliance with current health code
requirements. These are lower percentages than found in non-commercial foodservice
operations, such as hospitals, nursing homes, and elementary schools.
A follow-up study by the FDA (2004) found that 13% of full-service restaurants
were out of compliance for purchasing food from unsafe sources, 42.7% for poor
personal hygiene, and 63.8% for improper holding time and temperature. The percentages
of quick service restaurants out of compliance with these risk factors were lower with
2.3%, 31.2%, and 41.7%, respectively. Because of the relatively high incidence of
restaurants that are out of compliance with risk factors and food safety, restaurant

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managers should focus on those behaviors that are known to cause foodborne
illnesses and emphasize them in training.
Labensky and Hause (2007) stressed that although local health departments
regularly inspect all food service facilities, continual self-inspection and control are
essential for maintaining sanitary conditions. Therefore, one way to ensure compliance is
to frequently check and record the temperature of potentially hazardous foods during
cooking, cooling and holding. Maintaining written time and temperature logs allows
management to evaluate and adjust procedures as necessary. Furthermore, whatever
system is followed, all personnel must be constantly aware of and responsive to risks and
problems associated with the safety of the food they serve.
Results also revealed that the attitude towards food safety and sanitation of food
handlers is not significantly related to the level of regulations compliance of fast food
restaurants. This contradicted studies of Roup et al. (2009) where attitude has a lot of
influence on compliance, as shown in the studies of McGovern (2000); Armonio, et al
(2002); Chan and associates (2007); Suchitra and Devi (2007); and Gammon and
associates (2008).
Such also was the case supported by Askarian et al. (2006), as it indicated, that
attitude mediated the relationship between knowledge and compliance. Pittet (2004)
supported this statement and aptly termed it behavior modification. It was vital,
therefore, to find ways to improve attitude in order to improve compliance.

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Recommendations
In view of the findings, conclusions and implications, the following are
recommended:
1. Fast food restaurant owners and managers should continue to encourage their
food handlers to update themselves about food safety and sanitation thru trainings and
seminars.
2. Aware of the level of regulations compliance among fast food restaurants,
owners, managers and staff should continue to work for better compliance ratings.
Attention should be focused on requirements not complied.
3. Replication of this study to a wider scope is highly recommended. Aside from
the food handlers attitude towards food safety and sanitation and regulations, researchers
may include other variables such as knowledge and practices and other participants may
be included other than food handlers.

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REFERENCES

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APPENDICES

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Appendix A
Data Gathering Instruments

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Appendix A
Data Gathering Instruments
Dear Respondents:
This data-gathering instrument is intended to gather data for a graduate research
entitled, Food Safety and Sanitation: Attitude and Compliance of Fast Food Restaurant.
You are in the best position to supply the needed data for the purpose.
In this regard, kindly supply the information required on the space provided.
Please do not leave any item unanswered.
Thank you very much.
KENDRICK CALLAO
Researcher
Part 1 Respondents Profile
Name (Optional): _______________________________________ Date: _____________
Name of Establishment (Optional): ___________________________________________
Sex: Male

[ ]
Female [ ]

Age: Less than 20


21-30
31-40
Above 40

[
[
[
[

Industry Experience (in years): Under 1


15
6-10
Over 10

]
]
]
]

Educational Attainment: High School

[ ]
College Level [ ]
Post-Graduate [ ]

[
[
[
[

]
]
]
]

Job Position: Line Staff


Manager

[ ]
[ ]

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Part 2 Attitude towards food safety and sanitation


Directions:
Go over each item carefully and put a check () mark on the space that indicates
how much you agree or disagree with each statement. Please do not leave any item
unanswered.
Legend: SA-Strongly Agree; A-Agree; NS-Not Sure; D-Disagree; SD-Strongly Disagree
SA A NS D SD
1. I think sanitation is an important part of my job
responsibilities.
2. I believe that good employee hygiene can prevent foodborne
illness.
3. I think that it is the responsibility of all food handlers to ensure
that food is safe to serve.
4. I am willing to change my food handling behaviors when I
know they are incorrect.
5. I am willing to obtain more food safety knowledge.
6. It is more important to have tasty food rather than safe foodb.
7. I select a place to eat based on its reputation for good
sanitation and cleanliness.
8. I think that managers should educate employees on personal
hygiene and sanitation regularly.
9. I think that only full-time employees should receive food
safety training.
10. I believe that food safety knowledge does not only benefit my
work but also my personal life.
11. I am willing to attend a food safety training course.
12. I believe that food safety knowledge will make me more
confident about my work.

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Republic of the Philippines


OFFICE OF THE CITY HEALTH OFFICER
City of Iloilo
SANITARY INSPECTION OF FOOD ESTABLISHMENT

Establishment: ____________________________ Category: ______________________


Owner/Manager : _________________________________________________________
Address: _________________________________ Sanitary Permit No. ______________
No. of Personnel: __________________________ No. with Health Certificate ________
ITEMS
1. Protection of Prepared Foods

2. Suitability of Kitchen
3. Cleanliness of Utensils
4. Construction of Premises
5. Maintenance of Premises
6. Toilet Provision
7. Handwashing Facilities
8. Water Supply
9. Liquid Waste Management
10. Solid Waste Management
11. Wholesomeness of Food
12. Vermin Control
13. Cleanliness and Tidiness
14. Protection of Food
15. Personal Cleanliness
16. Housekeeping and Management
17. Condition of Appliances and
Utensils
18. Sanitary Condition of Appliances
and Utensils
19. Disease Control (Health Card)
20. Miscellaneous (Issuance of
Sanitary Permit)
TOTAL DEMERITS ---

DEMERIT

RECOMMEND
CORRECTIVE MEASURES

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Note: Non complying items are indicated with an (x). Every item is weighted a demerit
of 5. The rating of the establishment is therefore 100 (Number of demerit x 5).
The result expressed as a percentage (5) rating.
PERCENTAGE RATING
100% Less demerit score

SANITATION STANDARD PERCENTAGE RATING


EXCELLENT ----------------------90-100%

VERY SATISFACTORY ---------------- 70-89%


SATISFACTORY ------------------50-69%
Received by:
_______________________
Owner/Operator

Inspected by:
_________________________________
Sanitation Inspector
__________________________________
Date

Note: Original Copy Owner/Manager

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Appendix B
Letter to the City Health Officer

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Appendix B
Letter to the City Health Officer
January 22, 2014
MR. URMINICO M. BARONDA, JR. M.D.
City Health Officer
Iloilo City

Sir:

Warm Greetings!
I am presently writing a masters thesis entitled, Food Safety and Sanitation: Attitude and
Regulations Compliance among Fast Food Restaurants, in partial fulfillment of the
requirements for the degree, Master in Hospitality Management, at West Visayas State
University.
In connection with this, I would like to request for the results of compliance required by
the City Health on Sanitary Inspection of Food Establishment. These results will be used
as data for the above mentioned study.
Your favorable action regarding this request will be highly appreciated. Thank you very
much.

Very truly yours,


(SGD.) KENDRICK A. CALLAO
Researcher

Noted:
(SGD.) PROF. LOURDES F. ESPESOR
Dean, College of Business and Management

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Appendix C
Letter to the Managers

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Appendix C
Letter to the Managers

January 22, 2014


____________________
____________________
____________________
____________________
Sir/Maam:

Warm Greetings!
I am presently writing a masters thesis entitled, Food Safety and Sanitation: Attitude and
Regulations Compliance among Fast Food Restaurants, in partial fulfillment of the
requirements for the degree, Master in Hospitality Management, at West Visayas State
University.
In this connection, may I respectfully request permission from your office to allow me to
administer my instrument among your food handlers.
I am hoping for your favorable response regarding this request. Thank you very much.

Very truly yours,


(SGD.) KENDRICK A. CALLAO
Researcher

Noted:
(SGD.) PROF. LOURDES F. ESPESOR
Dean, College of Business and Management