Food Safety / Environmental Health:

Application for Temporary Food Service Permit

INSTRUCTIONS: This form is to be FILLED OUT COMPLETELY by the person or group who will be providing the food service.  The completed and  application must then be submitted to the office of Environmental Health & Safety for approval, no later than one week prior to the event.

Name of the Event
Date and Time of Event
Sponsoring Organization
Sponsoring Representative Name (Last, First)
Sponsoring Representative Phone
Sponsoring Representative email address
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 items will be served?
(List all foods and beverages.)
Will the event be catered?  If yes... Yes      No
Who is the caterer?         Approved Vendor List
Caterer Name
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

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By submitting this form you are agreeing that you have read and understood the Guidelines for Food Service attached to this form and will ensure that those guidelines are followed for the duration of the event.