Challenges of Health Department Food Safety Inspections

An Inspectors job is to ensure compliance with the rules, which in turn should result in safe food being served. They are government agents possessing enforcement authority to ensure safe food. That doesn’t mean that inspectors have to have a cop attitude. In fact, my experience is that inspectors who have the best interpersonal skills are by far the most effective in gaining compliance. There are lots of opportunities to teach food safety principles and work cooperatively with the industry. But inspectors are not just facilitators.” Jim Austin, Registered Sanitarian and Restaurant Inspector.

Jim Austin Registered Sanitarian
Jim Austin

What are the challenges to the food industry in food safety compliance?

There is a national standard for food safety preparation and inspection, the FDA Food Code. The code is revised every four years. Unfortunately it is a set of guidelines left to the states to embrace. Compliance is voluntary. Many states and or municipalities choose not to follow these scientifically based rules developed by over 600 food safety experts. As a result, national chains need to follow guidelines that vary state-by-state and municipality-by-municipality. Food workers relocating from one state or municipality to another often find themselves exposed to varied standards. That variability creates the first challenge.

The second challenge is the mistaken mentality of food industry management or ownership that it is the job of the health inspector is to give a “stamp of approval” on their restaurant. Even health departments don’t pretend to be the end all in food safety. The language from a typical health department web site makes it clear that the real responsibility for food safety lies with the food establishment: 

One inspection may not be representative of the overall, long-term sanitation of an establishment. On any given day, a restaurant may have greater or fewer violations than observed during an inspection. In addition, some violations noted on an inspection report may have been corrected at the time of the inspection, which are indicated on the report. Follow-up inspections may be conducted for specific critical violations that cannot be corrected at the time of the inspection. Additionally, follow-up inspections may be conducted for any other violation at the discretion of the inspector. Although Retail Food Establishments are inspected by the health department, it is the establishment’s responsibility to ensure that food safety procedures are followed.” Colorado

Yet a third challenge is the shrinking dollars for health inspections, especially foreign foods and some municipalities. That shrinking dollar creates a need to do more with less. Some restaurants are inspected only annually. Even the busiest may be inspected only quarterly. Often the inspections are prearranged. This all underscores the important void that the public can fill in ensuring a higher level of excellence in food safety. A motivated consumer can watch for standard violations. was founded on this principle. The rating system gives the public a tool to give objective feedback to restaurant management. The consumer can become the eyes for the busy manager or owner and can be a continual voice demanding excellence in food safety.

What are Common Restaurant Food Safety Violations?

Despite the variability in inspection standards and inspection limitations, there are common themes found in food safety violations. According to the Centers for Disease Control and Prevention, the top five violations are: improper holding or cooling temperatures, inadequate hand washing, improper cooking, contaminated food contact surfaces and food from unsafe sources. The Center for Science in the Public Interest in its “Dirty Dining Report”, has added an additional top five concerns based upon consumer input: employee cleanliness, rodents/insects, improper use of wiping cloths, ill restaurant workers and bare hand contact.

According to Bruce Kress RS, a seasoned Health Inspector with over thirty years of experience, the most common violations he encounters are: cook staff not knowing the correct temperature to cook meats, failure to use personal protective gear: gloves or hair restraints, cross contamination of foods in preparation and presence of pests, such as flies or other rodents in the kitchen. Mr. Kress shares his comments in a radio interview.

Bruce Kress Registered Sanitarian
Bruce Kress Registered Sanitarian

Here are some real Health Inspector stories that may turn your stomach.

A well-known restaurant in a large metropolitan city had a recurring mouse infestation, which had been identified and a health inspector had written orders to the owner to eliminate the rodents. The premise was re-inspected and a wait staff employee was observed taking a soup cup, which had mouse droppings in it, emptying the droppings onto a floor and using that same cup, filling it with soup, to serve to a customer. The Inspector stopped the soup from being served to the customer, immediately closed the restaurant for non-compliance to previous orders. The news of the restaurant’s closure made the newspaper. The restaurant re-opened after it complied with the written orders, but closed permanently a few weeks later, because the general public lost confidence in the establishment.

At a medium sized family restaurant, the health inspector observed a food preparation employee reusing lettuce and tomato, from a previous customer’s plate, for a new food order. This same restaurant was scraping off customer’s uneaten food (such as vegetables, beef, chicken, bones) and saving it to be used in the preparation of soups for the next day.

On a Monday morning, the health inspector received a call, from a local school district official, that approximately 60 of students became ill during a dance over the weekend. The students were experiencing vomiting and diarrhea. The school official suspected that the students had gotten sick after eating something they had been served by the school cafeteria on Friday. The inspector interviewed some of the students who had become ill and took a food history from them. Some of the students who had become ill had not eaten food from the cafeteria. Vomit and stool samples were taken to be analyzed. The inspector ordered that all of the lockers, doorknobs, desks, tables, and bathrooms be sanitized, twice a day, until lab reports returned. Further on site inspections at the school found that in many of the bathrooms, faucet handles were missing, preventing students from washing their hands after using the restroom. The lab report confirmed the Norovirus and the school district were ordered to replace the missing faucet handles.

The government health inspector shoulders considerable but not exclusive responsibility for ensuring food safety. With variability in food safety standards, infrequency of inspections and limited governmental funding, the public can assume an increasing role as the eyes and offer a voice in demanding food safety excellence. offers an objective pubic tool for promoting food safety at a grass roots level.


Author: Dr. Harlan Stueven, MD

Harlan Stueven M.D. is a Board-Certified Emergency physician with sub-specialization in Environmental Toxicology and Board Certification in Medical Toxicology. Starting his career in the USAF, he served as a Flight Surgeon and Environmental Health Consultant Physician where one of his duties was monitoring food safety. In his nearly 40-year practice, he treated a range of medical, surgical and poisoning emergencies. He has been a Medical Director and/or Chairman of several hospital-based Emergency Medicine Departments, served as the President of Emergency and Environmental Medicine consulting group, a physician group Chief Financial Officer and sat on many national, state and local committees. Dr. Stueven founded Dining Grades and the Dining Safety Alliance to improve food safety by increasing awareness of food borne illness and the formation of partnerships within the food industry. He is a consultant to the Wisconsin Retail Food Establishment Grading Work Group; a Co-investigator in a CDC funded “Evaluation of Health Department Restaurant Inspection Programs” project. He has presented at several National, State and Regional conferences on restaurant grading and food safety. He is an accomplished leader, medical researcher, a champion of process improvement, author, and national and international speaker.

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