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people to report gastrointestinal symptoms after consuming
hamburgers that contained contaminated bacon jam (22).
It is hypothesized that temperature abuse of the bacon jam
at both the bakery and the CNE led to conditions for S.
aureus bacteria present in the jam to grow and produce a
toxin that caused foodborne illness (22). This and hundreds
of other outbreaks of foodborne disease could be prevented
through proper food handling practices (26), which requires
appropriate training of food handlers.
Approximately 25% of Canadians consume at least one
food item prepared in a food premises each day (5). In
Ontario, the legal definition of a food premises is an establishment that stores, prepares, packages, serves, vends or
offers food for human consumption (6), such as restaurants,
grocery stores and food commissaries. A 2012 report on food
safety in Canada found that at least 50% of foodborne illness
outbreaks with a known source originated in a food premise
(14). Lapses in food safety by food handlers may be a result
of no training, improper training or declining food safety
knowledge (12). The safety of those who eat meals outside
of the home is largely in the hands of food handlers, whose
level of food safety knowledge is therefore important to the
protection of public health.
Food handler food safety training can help increase food
safety knowledge among food handlers, potentially reducing
the instance of foodborne illness and lowering the burden
associated with gastroenteritis (10). Across Canada, each
province and territory has its own guidelines recommending
or requiring food safety training for food handlers (29). In
most provinces and territories, training can be provided
by local public health units or accredited private agencies
(29). For example, TrainCan Inc. is a private company that
provides food handler certification training across Canada,
with the exception of the territories (31).
Despite the recognized importance of food handler
certification and training, only two provinces in Canada -
Newfoundland and Labrador, and Prince Edward Island -
require mandatory recertification or refresher courses (29).
In Ontario, it is suggested, but not required, by the Ontario
Ministry of Health and Long-term Care (MOHLTC), a
branch of the provincial government, that food handlers
renew their food safety certifications every five years (17).
In a previous study focusing on food service volunteers, it
was found that an increase in the display of positive food
safety behaviors was evident in food handlers after a food
safety training session (23). Moreover, food handlers can
experience a loss of food safety knowledge over time, or
may develop poor food handling habits (23). Retraining or
recertification of food handlers could refresh their food safety
skills and reinforce best practices, which could contribute to
reducing the incidence of foodborne illness caused by food
handlers in food premises (23). It was hypothesized that food
handlers in this study who more recently obtained their food
handler certification would perform better on the food safety

knowledge survey than those who obtained their certification
longer ago so that time elapsed from initial certification may
be associated with the level of food safety knowledge. This
research aims to identify the food safety knowledge level of
previously certified Canadian food handlers to determine
key knowledge strengths and gaps post-certification, as well
as the demographic variables associated with average food
safety survey knowledge scores. The results can help to
inform future research and governmental policies on food
handler recertification and retraining.
MATERIALS AND METHODS
Research design and participants
Former food handler training students of the TrainCan Inc.
"Basics.fst" program certified across Canada were surveyed
to assess their level of food safety knowledge. The "Basics.
fst" program is offered as a full day in-class training session
followed by an exam (28). To be eligible for this study,
participants must have successfully completed the TrainCan
Inc. "Basics.fst" course at any time on or before April 1,
2014, at least a year prior to the start of the study. A total of
2,257 potential participants were eligible and had provided
a contact E-mail address to TrainCan Inc. The food safety
survey was sent directly to the eligible 2,257 participants
via E-mail by TrainCan Inc. on March 30, 2015. A reminder
E-mail was sent out to potential participants a month after
the initial E-mail, requesting completion of the survey. Once
participants received the invitation E-mail from TrainCan
Inc. and entered the survey hosted online by ProProfs.
com, (ProProfs.com, Los Angeles, CA, USA), an Internet
based survey application, participants were presented with
an information page including consent information and
research objectives. The online survey software collected the
responses of each participant's demographic and food safety
questions. After participants completed the online survey,
their results were displayed by the survey software, including
the correct answers to incorrectly answered questions. The
survey was open for participation from March 30, 2015,
to June 10, 2015, a total of 72 days; it was closed on June
10, 2015, two weeks after the last completed survey was
submitted by a participant. Participants were compensated
for their time with an entry into a drawing for one of three
$25 CAD gift certificates to a retailer or food premises of
their choice. This research was approved by the University of
Guelph Research Ethics Board prior to the implementation
of the project.
Instrument development
The online survey, offered in English only, consisted of
multiple choice format questions divided into two sections.
The first section focused on participant demographics:
gender, age, years lived in Canada, highest level of school or
highest degree completed, years worked in the food industry,
holding a managerial or supervisory role, speaking English

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