To assess the level of food safety knowledge, perceptions, and self-reported food-handling behaviors among middle school students. Baseline questionnaire administered in class that assessed background characteristics, knowledge, behaviors, and perceptions related to food safety. 178 seventh and eighth grade students from 4 schools in central Pennsylvania. Food safety knowledge, perceptions, and self-reported food-handling behaviors. Independent samples t test tested differences between genders and bivariate correlation analysis explored associations among knowledge, perceptions, and behavior (P < .05). Food safety knowledge score was 7.2 ± 1.6 of a maximum of 10 points. Perceived self-efficacy and severity of a foodborne illness were high, but perceived susceptibility was low. Girls scored higher on the self-efficacy and severity scale (P < .01). Self-efficacy correlated positively with knowledge and behavior (P < .0001) and severity with knowledge (P < .01). One fifth reported taking risks in food handling and one fifth reported having been sick because of something they ate. There is a disconnection between middle school students' food safety knowledge, perceptions, and behaviors. A need for relevant and motivating food safety education exists in this group.