Temporary Food Establishment Permit
Please complete the questions below.
Name
*
First Name
Last Name
Email
*
example@example.com
Address of Business or Person Applying for permit
*
*
Are all foods from an approved source? (approved sources include permitted markets, wholefood suppliers, commercial food suppliers) (No canned foods permitted or non approved USDA meat.)
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Yes
No
Will all time temperature controlled foods including meats, dairy products, poultry and other related foods be cooked at the correct temperatures?
*
Yes
No
Please check each box if all the standards apply.
*
Food will be prepared and cooked on site or in a regulated food establishment kitchen.
A thermometer will be on hand with a range of 32-165 degrees.
Hot Storage-135 degrees or higher is NOT allowed (crock pot), food must be at 135 degrees within 2 hours
Cold storage of 41 degrees or lower. Packed ice will be drained to prevent water from pooling.
I will "bare no hand contact" with food. I will use gloves, deli paper, tongs, or other utensils to handle food. The public will NOT serve themselves food from a communal container such as bags of buns, bags of chips with their hands. This is help prevent bare use of hands. Click "yes" if you can comply or "no" if not.
*
Yes
No
Does at least 1 person have a current food handler's card? If only one food handlers permit present then that individual must supervise all workers handling food. Food handler's card MUST be present at location.
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Yes
No
To have a clean handwashing station and adequate water supply please read the following. Please check if you comply with the following.
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Hand washing station must include soap, paper towels, clean water to run over hands. (A hand-dipping bucket is NOT adequate or sanitary.)
The hand washing station is within 10 feet of cooking area.
Hands will be washed before putting on gloves and between each glove change.
Hands will be washed after handling money and before putting on gloves or touching food.
There will be a wiping cloth and sanitizer available for wiping spills.
Hand sanitizing station will follow proper temperature and concentration (Chlorine: 50 to 100 ppm at 75 degrees or Quats: 200ppm at 75 degrees.)
The booth or area will be constructed in order to minimize the entrance of flies, vermin, dust and any other form of contamination. The cooking area will be restricted for the public's protection.
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Yes
No
I will NOT store plastic utensils, paper plates, napkins, or other single serve items on the floor/ground.
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Yes
No
I agree that all condiments (ketchup, mustard, sugar, salt, etc.) will come from individually wrapped, pour, pump, or squeezer container.
*
Yes
No
I agree that all garbage will be properly bagged prior to discarding into a main refuse/garbage container.
*
Yes
No
Ice will be dispensed from an approved container using a handle scoop.
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Yes
No
1
Will all food will be cooked to these temperatures and times from the above table?
Yes
No
Is a food handler card holder present at event?
*
Please Select
YES
NO
Where will food be prepared?
*
FOOD CANNOT BE PREPARED IN PRIVATE KITCHENS/HOMES
Menu
*
Please include the all menu items
Temporary Food Establishment Permit (please choose category 1 or category 2, read the descriptions below)
*
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( X )
Category 1
(food that requires NO serving time/temperature) Examples include: candy, soda, cotton candy.
$
20.00
Category 2
(food that requires serving time/temperature) Examples include: cooked food, hot dogs, chicken, hamburgers, etc.
$
150.00
Credit Card
I HAVE READ THE REGULATIONS ON THIS APPLICATION AND THE SPECIFIC REQUIREMENTS, AND AGREE TO COMPLY WITH THESE AND ANY OTHER INSTRUCTIONS FROM THE TRICOUNTY HEALTH DEPARTMENT.
*
Temporary Food Establishment Permit will be emailed to email on this application.
Submit
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