The challenge of eating safely may be greater than you think.

More than 76 million Americans develop foodborne illnesses annually, about 325,000 of those people are hospitalized and approximately 5,000 die, the U.S. Centers for Disease Control and Prevention estimates.

The horrific cases grab headlines – a 2011 listeria outbreak from cantaloupes that killed 30; a 2008 salmonella outbreak in peanuts that killed nine; a 1993 Jack in the Box E. coli outbreak that killed four – but most people only suffer the effects for a day or two.

“Symptoms are similar to that of the flu,” said Lori L. Till, a food safety instructor and associate professor in the SUNY Buffalo State Hospitality and Tourism Department.

Till teaches a food safety and sanitation class at Buffalo State in which she sends students to restaurants across the region for “Dining Out” assessments. In the more than 300 restaurants tested during the last decade, these students have found that nearly half don’t have their health inspections prominently displayed, more than one-third don’t have employee hand-washing signs in their restrooms and only about one in 20 has a cleaning list visible to the public. (They’ve also determined the average wait time for a table is 8.2 minutes.)

Whether you plan to eat out or at home, there are several ways to prevent foodborne illnesses, said Till, one of three certified ServSafe food safety instructors in New York State:

When eating out

1. Check out the bathroom: “One thing that’s critical is to visit the restrooms,” Till said, because they are a window on parts of a restaurant you can’t see. Is there enough soap and toilet paper? Are there enough paper towels? Are the sinks, floors, walls, mirrors and toilets clean?

Is there a sign above the sinks that reads, “Employees must wash hands”? That sign is required by the state Health Department. “That is why it’s posted, and it’s supposed be in a conspicuous location,” Till said, pointing out that restaurant workers in most establishments don’t have separate bathrooms.

2. The health inspection certificate: This provides no details about the latest inspection but confirms the restaurant passed, as well as gives the renewal date. “That also should be in a conspicuous location,” Till said, and restaurants should be proud of the accomplishment. Her Dining Out students who couldn’t find one during their visits have asked managers why and often been told, “We have it on file,” which tends to lead to more questions, Till said. A ServSafe certificate shows that staff has received extra food safety training.

3. The wait staff: Is your server wearing a name tag or announced her name and written it on your check? “Let’s say I was dining out yesterday, and I was starting to have a foodborne illness,” Till said. “If I want to file something with the health department, they’re going to want a history and will ask for the name of the server.” Servers with hair longer than shoulder length should have it pulled up, Till said, and kitchen staff should wear a hair net or hat. The wait staff’s attire or uniforms should be clean.

4. The table setting: “Is everything pristine?” Till asked. “You can have some problems if a dishwasher isn’t temping properly or the sanitizer isn’t working efficiently. You could end up with a glass with lipstick still on it.” Also look over the silverware. Ask for clean tableware if needed.

5. Food temperature: “When food is prepared, it has to be properly temped to kill any microorganisms,” Till said. Microorganisms grow best in temperatures between 45 and 140 degrees Fahrenheit, according to the state Health Department. A steak with a core of 145 degrees when served assures germs that can cause illness have been killed. It takes time for organisms to find their way back to food, Till said. Still, she said, to be safe, “Hot should be hot and cold should be cold.” If food isn’t piping hot when delivered to your table, send it back.

When eating in

1. Cooking methods: Which is safer, oven, stovetop or microwave? Microwave cooking can be the most challenging, Till said, unless you pull out food periodically and stir it, so it’s cooking evenly and getting hot enough everywhere to kill microorganisms. As for the others, “I don’t know if there is one better than other,” she said. “It’s a preference. What’s really important is the temperature of the food.”

2. Food handling and surfaces: Chicken, pork, beef and seafood “should be on their own separate surface that has been cleaned and sanitized,” Till said. Countertops and cutting boards should be washed “very thoroughly” with soap and water to avoid cross-contamination that could expose other foods. When it comes to cleaning cutting boards – Till uses more than one at a time, depending on the mix of foods – “I prefer using a dishwasher” which heats to 180 degrees, she said. She called antibacterials, which have raised concerns about creating a class of “super bugs,” the products of a “marketing strategy.”

3. Food storage: There is a methodology for refrigerator food storage, Till said, starting at the top: any ready-to-eat food (salads, fruits, veggies, liquids); seafood; whole-cut beef and pork (“There’s more density to these food items”); ground meats and fish; whole or ground poultry. “The bottom food item would be poultry,” Till said, “because it does have the potential to be drippy.” Produce is safe when in separated crispers at the bottom of a fridge, she added.

4. Thawing food: “The best way to thaw is really in the refrigerator,” followed by using a microwave, Till said. Food left out on a counter thaws from the outside in and can quickly get to the germ-promoting range of 45 to 140 degrees. You can place bagged frozen chicken or other meats into a colander and run cool water over it. “It will eventually thaw out,” she said. “Hot water brings you into a temperature range that begins to make that food dangerous.”

5. Produce: Rinse “thoroughly and vigorously” with cool water using a dollop of dish detergent and scrubber.

6. Sell by dates: “Sell-by date products typically include milk, yogurt, deli meats and dough products,” Till said. “They indicate the last day the product is at its best quality. I would not go past that in a commercial operation,” she said, “but often products such as milk and yogurt can be consumed after the sell-by date if they have been kept at the correct temperatures and for up to one week if they have not been time-temperature abused.” “Best if used by” indicates food quality, not food safety, as determined by the manufacturer.