Get Form 1a, Conditional Employees - Maricopa

Filling out the Form 1A, Conditional Employees - Maricopa, is essential for ensuring food safety and preventing the transmission of foodborne illnesses. This guide will provide clear, step-by-step instructions to help users complete the form accurately and efficiently online.

Follow the steps to fill out the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the conditional employee's name in the designated field, ensuring that it is printed clearly.
3. Next, input the food employee's name in the specified area, similarly printed clearly.
4. Fill in the address section with the complete mailing address of the conditional employee, ensuring accuracy.
5. Provide the daytime and evening telephone numbers in the appropriate fields.
6. Record the date of filling out the form in the indicated section.
7. Respond to the symptom questions by circling 'YES' or 'NO' to indicate if the conditional employee is suffering from any listed symptoms. If 'YES', provide the date of onset.
8. For the history of diseases section, follow the prompts to answer questions regarding past conditions, including being diagnosed with typhoid fever and taking antibiotics.
9. Respond to exposure history questions, indicating if the conditional employee has been exposed to a confirmed foodborne disease outbreak and provide details as requested.
10. Complete the health practitioner information section by providing the name, address, and contact numbers of the individual's healthcare provider.
11. Finally, ensure that all signatories — conditional employee, food employee, and permit holder or representative — have signed and dated in the appropriate sections.
12. After reviewing all entries for accuracy, save changes to the form, and proceed to download, print, or share the completed document as necessary.

Complete your documents online to maintain food safety and compliance.