Environmental Health & Safety

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Instructions: Use this form to obtain a Food Permit for temporary events. All fields are required to be completed. Food Permit training is a prerequisite to obtaining a food permit. Please note that this form must be submitted no later than one week prior to the event.

Event Name:
Event Date/Time:
Organization:
Name of Requestor: (last, first)
Phone:
Email:
Name of representative that completed the Food Safety Training class: (last, first)
Will food be served to people other than members of the sponsoring organization?	Yes No
How will you prepare/cook the food?
What food and beverage items will be served? (List all)
Will the event be catered?	Yes No
Caterer Name (Pre-Approved Caterers)
Caterer Phone:
Where will the food be obtained?
Where will the food be prepared?
How will the food be kept hot and/or cold? (i.e., chafing dish, grill, wok, etc.)
Where will the food be served?
Will alcohol be served at this event?	Yes No
Please enter in the verification code shown below: *

For assistance with this form, please contact Environmental Health (951) 827-5528.