Required fields are marked with asterisks (*)

Special Event Food Vendor Application

This form is for special event food vendors only. This application must be submitted 30 days prior to the event.

Event Details

Event name:

Event location/address

Event start date:

Event end date:

Event start time:

Event end time:

Is this an annual event?

Yes

Vendor Information

Name of Vendor:

Concession name:

Contact name:

Email address of contact:

Day phone:

Evening phone:

Cell phone:

Fax number:

Are you a vendor from outside of Huron and Perth Counties?

Yes

If yes, attach a copy of your most recent inspection report from your local health unit.

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Type of set up at event (check all that apply):

Preparation/serving kitchen

Temporary booth

Mobile catering truck or cart

Other

If other, please define:

Will a certified food handler be on-site?

Yes

Food menu items

Please list what you will be serving at the event; this includes samples (e.g. vegetable soup with chicken stock base, chili with beef, cookies, cheese, bottle jams or jellies).

Food menu item:

Source of food/supplier:

Location of food preparation:

Food menu item:

Source of food/supplier:

Location of food preparation:

Food menu item:

Source of food/supplier:

Location of food preparation:

Food menu item:

Source of food/supplier:

Location of food preparation:

Food menu item:

Source of food/supplier:

Location of food preparation:

Food menu item:

Source of food/supplier:

Location of food preparation:

Food menu item:

Source of food/supplier:

Location of food preparation:

How will food be transported to the event (check all that apply):

Refrigerated truck

Coolers with ice

Thermal unit (cambro units)

Insulated container/bag

Other

Describe other:

Food Safety Details

How are you keeping food cold and/or hot during the event (check all that apply)

Refrigeration/freezer

Coolers with ice

Thermal unit (cambro units)

Chaffing dishes/steam table

Barbeque/grill

Crock pot

Hot plate

Not applicable

Other

Describe other:

Will you have a thermometer available at the event to check the internal temperature of perishable foods?

Yes

Please describe your potable water source (ensure you have the following: potable water, liquid soap, paper towel, waste bucket).

Please describe your handwashing set-up a hand washing station must be available at your booth for food handlers). If offering only pre-packages food (e.g. pop, chips, etc.) you are exempt from this requirement, however hand sanitizer is required.

Fixed sink

Temporary hand wash station

Hand sanitizer

Other

How will you ensure a clean supply of service utensils (check all that apply)?

Extra utensils

Cleaning and sanitizing dishes with a 2 compartment sink

Cleaning and sanitizing dishes with a 3 compartment sink

What method of sanitizing will you be using for utensils and/or food contact surface (i.e. tables)?

Chlorine (100 ppm)

QUAT (200 ppm)

Iodine (25 ppm)

Other

Describe other:

Are garbage bins supplied (garbage must be disposed at least daily)?

Yes

Is storage for food provided so that it is at least 15 cm off the ground?

Yes

Upload a floor plan (optional)

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Special Events' Information

Include all special events you plan to attend for the year within Huron and Perth counties. You don't need to submit a new application for each event. If you miss including an event on this form, contact Huron Perth Public Health and we will adjust your file.

Event name:

Event location/address

Event start date:

Event end date:

Event start time:

Event end time:

Is this an annual event?

Yes

Event name:

Event location/address

Event start date:

Event end date:

Event start time:

Event end time:

Is this an annual event?

Yes

By checking this box, I acknowledge I have read, understand, and agree that the information provided in this form is correct.

Yes

The personal information on this form is collected under the authority of The Health Protection and Promotion Act, R.S.O. 1990, c. H. 7. It will be used for ownership identification and enforcement of the Act and the applicable Regulations under the Act.

Forms

Special Event Food Vendor Application

Event Details

Vendor Information

Food menu items

Food Safety Details

Special Events' Information