Restaurant Inspection Reports as a Proxy Measure for Occupational Health and Safety: South Asian Restaurant Workers in New York City

	BRONX	BROOKLYN	MANHATTAN	QUEENS	STATEN ISLAND	NYCTotal	% of total in NYC
Indian
GRADE A	7	51	125	82	7	272	81%
GRADE B	1	8	5	12	1	27	8%
GRADE C	0	1	5	1	0	7	2%
GRADE PENDING	0	4	10	6	0	20	6%
CLOSED	0	0	3	0	0	3	1%
TOTAL	8	64	148	107	8	335
Bangladeshi
GRADE A	4	5	4	15	–	28	74%
GRADE B	0	0	2	3	–	5	13%
GRADE C	0	0	1	0	–	1	3%
GRADE PENDING	1	3	0	0	–	4	11%
CLOSED	0	0	0	0	–	0	0%
TOTAL	5	8	7	18	–	38
Pakistani
GRADE A	3	10	5	9	1	28	85%
GRADE B	0	1	0	2	0	3	9%
GRADE C	0	0	0	0	0	0	0%
GRADE PENDING	0	1	0	1	0	2	6%
CLOSED	0	0	0	0	0	0	0%
TOTAL	3	12	5	12	1	33

Table 2

Critical violations in Restaurant Inspection and its possible implication for worker health and safety (Courtesy: New York City Department of Health and Mental Hygiene).

Violations	Implication on Worker Health and Safety
Live roaches present in facility’s food and/or non-food areas.	Cockroaches are sources of allergens in the workplace especially for asthmatics and people with conditions like Allergic Rhinitis or atopic allergic conditions; Potent allergens are released from the saliva secretions, cast skins, dead bodies of cockroaches. Cockroaches have been suspected to specific disease outbreaks; it can carry Salmonella typhimurium, Entamoeba histolytica, and the poliomyelitis virus
Filth flies or food/refuse/sewage-associated (FRSA) flies present in facility’s food and/or non-food areas. Filth flies include house flies, little house flies, blow flies, bottle flies and flesh flies. Food/refuse/sewage-associated flies include fruit flies, drain flies and Phorid flies.	Housefly (Musca domestica)’s close association with people, its abundance, and its ability to transmit disease make it a great threat to human. Each housefly can easily carry more than 1 million bacteria on its body. Some of the disease-causing agents transmitted by houseflies are Shigella spp. (dysentery and diarrhea = shigellosis), Salmonella spp. (typhoid fever), Escherichia coli, (traveler’s diarrhea), and Vibrio cholerae (cholera). These organisms can be carried on the fly’s tarsi or body hairs, and frequently these are regurgitated onto food when the fly attempts to liquefy it for ingestion. Acute gastrointestinal problems can be related to these conditions and employees can become reservoir for outbreaks of these deadly diseases.
Evidence of mice or live mice present in facility’s food and/or non-food areas.	Rodent-associated diseases affecting humans include plague, murine typhus, leptospirosis, rickettsial pox, and rat-bite fever. Animal bites can cause lacerated wounds with the potential for secondary bacterial infections. Mice infested workplaces are hazardous for employees. Allergies to vermins can also potentially cause or exacerbate one’s pulmonary, upper respiratory tract and skin conditions (allergic dermatitis)
Hot food item not held at or above 140°F. Cold food item held above 41°F (smoked fish and reduced oxygen packaged foods above 38°F) except during necessary preparation.	These conditions can cause bacterial growth in the meat, poultry, eggs, seafood, dairy products. These can potentially cause the outbreak of gastroenteritis or other acute GI related conditions for employees consuming this food. Sub-standard heating and cooling services for food storage/preparation point to a lack of other provisions and necessary equipment to ensure a safe workplace.
Sanitized equipment or utensil, including in-use food dispensing utensil, improperly used or stored No facilities available to wash, rinse and sanitize utensils and/or equipment. Wiping cloths soiled or not stored in sanitizing solution.	Musculoskeletal injuries and concussion related to utensils falling over. Sprain/strain and slip and fall injuries from cluttered tight spaces with limited maneuverability. Lack of space to store equipment points to confined spaces and possible fire hazards. Improper storage in the dishwashing area can lead to slips, trips and falls. Inadequate space for dishwashing may lead to repetitive strain traumatic injuries
Food not protected from potential source of contamination during storage, preparation, transportation, display or service. Raw, cooked or prepared food is adulterated, contaminated, cross-contaminated, or not discarded in accordance with HACCP plan.	These conditions can cause bacterial growth in the meat, poultry, eggs, seafood, dairy products. These can potentially cause the outbreak of gastroenteritis or other acute GI related conditions if food is consumed by the employees.
Tobacco use, eating, or drinking from open container in food preparation, food storage or dishwashing area observed.	Indoor smoking in the restaurant can lead to tobacco related exposures and second-hand smoking to the workers. Can be a fire hazard.
Food Protection Certificate not held by supervisor of food operations.	Not displaying this certificate may indicate a behavior of ignorance, unawareness or willful disregard. Ensuring healthy and safe workplace is highly unlikely in such a workplace and underreporting of work injuries will be common.
Personal cleanliness inadequate. Outer garment soiled with possible contaminant. Effective hair restraint not worn in an area where food is prepared.	Non-adherence to the hygienic practices indicates lack of proper training of the employees to adopt basic handling practices. Employees are unlikely to have any training on workplace safety. In some cases, employees’ exhibiting of these behaviors could be related to anxiety, depression, or stress resulting from the extreme economic insecurity or uncertainty.
Food contact surface not properly washed, rinsed and sanitized after each use and following any activity when contamination may have occurred. Food worker does not use proper utensil to eliminate bare hand contact with food that will not receive adequate additional heat treatment.	Lack of adequate washing of the utensils or cleanliness indicates non- adherence to basic hygienic practices and may lead to a host of illnesses among employees.
Hand washing facility not provided in or near food preparation area and toilet room. Hot and cold running water at adequate pressure to enable cleanliness of employees not provided at facility. Soap and an acceptable hand-drying device not provided.	Sink accessibility promotes handwashing. Similarly, glove accessibility is related to glove use. Some workers may not know that food needs to be protected from dirty hands. Glove use may need less handwashing. Workers wearing of gloves may not be a common practice in these ethnic restaurant establishments.