Abstract: At 12:00 p.m. on December 13, 2017, an employee and two co-workers were preparing food for a restaurant. Another co-worker, a server, was preparing for the beginning of the lunch shift. The employee and coworkers reported experiencing a dry cough and trouble breathing. The server reported a strong odor of ammonia in the dining area of the restaurant. The employee sought fresh air due to respiratory distress from cleaning chemicals. An hour in fresh air did not alleviate the employee's symptoms. The employee requested transportation to an emergency room. The employee was on a ventilator for two days. The employee sustained respiratory distress from exposure to ammonia-based cleaning chemicals or the from chemicals created by a reaction between ammonia-based chemicals and bleach-based cleaners.