Special Event – Vendor - All-in-One Software for Growing ...



Temporary Food Establishment ApplicationEvery Food Vendor must complete all five pages of this application and forward it to the Event Organizer. Event Information Name of the Event: FORMTEXT ?????Location of the Event: FORMTEXT ?????Event Address: FORMTEXT ?????(Municipal Address, Park Name or Street Closure Boundaries)Event Organizer/Organization: FORMTEXT ?????Vendor InformationOn-site Contact Person: FORMTEXT ?????On–site Cell #: FORMTEXT ?????Booth Name and Booth Number, if applicable: FORMTEXT ?????Date(s) at the Event: FORMTEXT ?????Number of Certified Food Handlers that will be On-site: FORMTEXT ?????Proof of certification available at the boothBusiness/Organization Name: FORMTEXT ????? Address: FORMTEXT ????? Phone #: FORMTEXT ?????E-mail: FORMTEXT ?????Municipal License Number: FORMTEXT ?????List of On-Site Equipment and Supplies for Operational NeedsCheck items that will be available.Temporary Food Booth FORMCHECKBOX Supply of potable water for cooking and cleaning FORMCHECKBOX Leak-proof container(s) for waste water FORMCHECKBOX Garbage container with supply of plastic garbage bags FORMCHECKBOX Power source/backup (e.g. generator, propane burner) FORMCHECKBOX Platform (15 cm /6") to elevate food, food containers and paper goods above the ground FORMCHECKBOX Cleaning supplies (e.g. detergent, wiping cloths) FORMCHECKBOX Clean, smooth, washable tables and storage areas FORMCHECKBOX Overhead booth covering (e.g. canopy, umbrella)Food Safety Equipment FORMCHECKBOX Hot holding unit to maintain hot foods at 60oC (140oF) or higher (e.g. chafing dishes, hot plates) FORMCHECKBOX Probe thermometer(s) FORMCHECKBOX Cold holding units to maintain cold foods at 4oC (39oF) or lower (e.g. coolers, refrigerators, freezers) FORMCHECKBOX Thermometer(s) for each storage unit containing hazardous foods FORMCHECKBOX Ice for food storage separate from ice for consumption (from an approved source) FORMCHECKBOX Scoops to dispense ice for consumption FORMCHECKBOX Plastic wrap/aluminum foil for protecting food FORMCHECKBOX Backup supply of clean utensils (4 sets of each) FORMCHECKBOX Food grade storage containers FORMCHECKBOX Hair restraint (e.g. hairnets , caps, hats) FORMCHECKBOX Clean aprons for food handlersHand Washing Facilities FORMCHECKBOX Liquid soap in a dispenser FORMCHECKBOX Paper towels FORMCHECKBOX Potable water supply with continuous flow FORMCHECKBOX Waste water containerHand Washing facility must be one or more of the following: FORMCHECKBOX Portable or free standing hand wash station FORMCHECKBOX Gravity fed water container with spigot set up on a table FORMCHECKBOX Other FORMTEXT ?????Note: Hand sanitizers do not replace the requirements for a temporary hand wash station Sanitizing Solution Supplies needed to make sanitizer on site FORMCHECKBOX Water FORMCHECKBOX measuring cup and teaspoon FORMCHECKBOX Labeled spray bottle Sanitizer FORMCHECKBOX Chlorine (Bleach) FORMCHECKBOX Quaternary ammonium FORMCHECKBOX Iodine FORMCHECKBOX Test strips to check sanitizer strengthList of Food SuppliersName of Supplier: FORMTEXT ?????Contact Person (if applicable): FORMTEXT ?????Address: FORMTEXT ?????Phone # : FORMTEXT ?????E-mail: FORMTEXT ?????List Food(s) Obtained from this Supplier: FORMTEXT ?????Name of Supplier: FORMTEXT ?????Contact Person (if applicable): FORMTEXT ?????Address: FORMTEXT ?????Phone # : FORMTEXT ?????E-mail: FORMTEXT ?????List Food(s) Obtained from this Supplier: FORMTEXT ?????Name of Supplier: FORMTEXT ?????Contact Person (if applicable): FORMTEXT ?????Address: FORMTEXT ?????Phone # : FORMTEXT ?????E-mail: FORMTEXT ?????List Food(s) Obtained from this Supplier: FORMTEXT ?????Name of Supplier: FORMTEXT ?????Contact Person (if applicable): FORMTEXT ?????Address: FORMTEXT ?????Phone # : FORMTEXT ?????E-mail: FORMTEXT ?????List Food(s) Obtained from this Supplier: FORMTEXT ?????Name of Supplier: FORMTEXT ?????Contact Person (if applicable): FORMTEXT ?????Address: FORMTEXT ?????Phone # : FORMTEXT ?????E-mail: FORMTEXT ?????List Food(s) Obtained from this Supplier: FORMTEXT ?????Please attach additional pages as neededFood ItemName of food Item and ingredients: FORMTEXT ?????How is it prepared? FORMTEXT ?????Will this food be pre-cooked? FORMCHECKBOX orWill this food be cooked on-site? FORMCHECKBOX Where is the food prepared (list full address)? FORMTEXT ?????Will the food be transported FORMCHECKBOX Yes FORMCHECKBOX No Type of container used to transport food(s) to maintain temperatures? FORMTEXT ?????How will proper temperatures for hazardous foods be maintained at the event (e.g. coolers, warming ovens)? FORMTEXT ?????Food ItemName of food Item and ingredients: FORMTEXT ?????How is it prepared? FORMTEXT ?????Will this food be pre-cooked? FORMCHECKBOX orWill this food be cooked on-site? FORMCHECKBOX Where is the food prepared (list full address)? FORMTEXT ?????Will the food be transported FORMCHECKBOX Yes FORMCHECKBOX No Type of container used to transport food(s) to maintain temperatures? FORMTEXT ?????How will proper temperatures for hazardous foods be maintained at the event (e.g. coolers, warming ovens)? FORMTEXT ?????Food ItemName of food Item and ingredients: FORMTEXT ?????How is it prepared? FORMTEXT ?????Will this food be pre-cooked? FORMCHECKBOX orWill this food be cooked on-site? FORMCHECKBOX Where is the food prepared (list full address)? FORMTEXT ?????Will the food be transported FORMCHECKBOX Yes FORMCHECKBOX No Type of container used to transport food(s) to maintain temperatures? FORMTEXT ?????How will proper temperatures for hazardous foods be maintained at the event (e.g. coolers, warming ovens)? FORMTEXT ?????Please attach additional pages as neededBooth Set-upIndicate on drawing or electronic copy (all applicable equipment) FORMCHECKBOX Hand wash station(s) FORMCHECKBOX Additional sink(s) FORMCHECKBOX Cooking equipment FORMCHECKBOX Work tables FORMCHECKBOX Container(s) for waste water FORMCHECKBOX Garbage container(s) FORMCHECKBOX Food and supplies storage areas FORMCHECKBOX Refrigerated trucks & other off-site storageLocation FORMTEXT ????? FORMCHECKBOX Power source/ backup FORMCHECKBOX Overhead booth covering Type FORMTEXT ????? FORMCHECKBOX Protective Barrier for cooking equipment ................
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