The occupational health nurse in a large manufacturing facility arrives at work early one Monday morning to find three ill employees in the clinic waiting room and a message from several plant supervisors that multiple employees have called in sick. The supervisors are concerned. The employees have reported similar symptoms, including nausea, vomiting, diarrhea, and fever Furthermore, two supervisors who rarely miss work have also called in sick and other employees are complaining of stomach cramps and diarrhea. The occupational health nurse promptly begins completing a nursing assessment and health history. She discovers that all sick employees attended the company picnic, catered by the facility's food service vendor, the day before. After notifying the local public health department, the occupational health nurse begins to investigate further. The occupational health nurse visits the cafeteria to speak with the manager and inquire about the food served at the picnic. The menu included ham and cheese sandwiches with mayonnaise, hamburgers, potato salad, and cake. The beverages were milk, non-bottled water, and lemonade. All leftover food was discarded, so nothing is available for testing. The manager mentions that yesterday was particularly hot, with a high of 93 degrees F. He states the local health department conducts regular, stringent food inspections. However, he admits they have been short staffed recently and, although he tries to provide adequate training and oversee all food service operations, a few new employees worked at the company picnic. He also mentions his holding temperature logs are "not exactly up-to-date." While talking to the manager the occupational health nurse notices one of the food service employees cutting raw vegetables on a wooden cutting board just used to cut raw chicken. The cutting board was wiped with a damp, visibly soiled sponge, rather than washed, after cutting the meat. It is abundantly clear that food safety training deficiencies exist in this food service. Seventy percent of the employees who attended the company picnic are too ill to work, and absenteeism leads to production shutdown. The culprit? Salmonella. Because of the number of cases, the local health department initiates an investigation and the facility is issued a citation.