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1 of 3 TEMPORARY EVENT FOOD ESTABLISHMENT LICENSE APPLICATION Must be submitted 30 days prior to event. IDAHO FOOD CODE 8-302.11 Your application may be denied if not submitted within specified time frame. PLEASE PRINT CLEARLY Establishment Information: Establishment Name (Booth Name): Establishment Mailing Address: (City) (State) (Zip) Establishment Telephone: Establishment Fax: E-mail: Non-Profit Group: Yes No Name of Non-Profit Group: Accredited Food Safety Manager (Circle one) – 360 Training – ServSafe – – Above Training/State Food Safety – Prometric Idaho Temporary Food Safety Certification Menu Items: 5. 14. No additional menu items may be added to this application after license is issued. Establishment Ownership: Legal Ownership of Establishment: Mailing Address: (City) (State) (Zip) Ownership Telephone: Ownership Fax: E-mail: Booth Person-in-Charge: Telephone: Cell Phone: Secondary Booth Contact: Telephone: Cell Phone: Operators of Temporary Event Food Establishments must complete the following sections, sign, date, and attach all supporting documentation to this application. Ada & Boise Counties: 707 N Place Elmore County: 520 E. 8th N. Valley County: 703 N. 1st Street Boise ID 83704-0825 Mountain Home ID 83647 McCall ID 83638 [PHONE REDACTED] Fax:[PHONE REDACTED] [PHONE REDACTED] Fax:[PHONE REDACTED] [PHONE REDACTED] Fax:[PHONE REDACTED] ENVIRONMENTAL HEALTH CDHD Use Only: Fee: Date Received: Receipt # Received by: License # Risk Assessment: L M H FBN Approval Date: Approved Disapproved Unregulated EHS Consultation: Time Log: Time Min. EHS# / Act____ Time Min. EHS# / Approved Training: Yes Req. Exempt ---PAGE BREAK--- 2 of 3 Planned Events / Locations 1. Event Event Opening Date: Closing Date: Coordinator Name: Coordinator Phone # : Water Source Name: Public or Private Sewage Disposal: Public or Private Vendor Set-up Date Time 2. Event Event Opening Date: Closing Date: Coordinator Name: Coordinator Phone # : Water Source Name: Public or Private Sewage Disposal: Public or Private Vendor Set-up Date Time 3. Event Event Opening Date: /_____Time Closing Date: Coordinator Name: Coordinator Phone # : Water Source Name: Public or Private Sewage Disposal: Public or Private Vendor Set-up Date Time 4. Event Event Opening Date: /_____Time Closing Date: Coordinator Name: Coordinator Phone # : Water Source Name: Public or Private Sewage Disposal: Public or Private Vendor Set-up Date Time 5. Event Event Opening Date: /_____Time Closing Date: Coordinator Name: Coordinator Phone # : Water Source Name: Public or Private Sewage Disposal: Public or Private Vendor Set-up Date Time 6. Event Event Opening Date: /_____Time Closing Date: Coordinator Name: Coordinator Phone # : Water Source Name: Public or Private Sewage Disposal: Public or Private Vendor Set-up Date Time 7. Event Event Opening Date: /_____Time Closing Date: Coordinator Name: Coordinator Phone # : Water Source Name: Public or Private Sewage Disposal: Public or Private Vendor Set-up Date Time Approved Approved Approved Approved Approved Approved Approved ---PAGE BREAK--- 3 of 3 1. List where all food items and ice will be purchased (names of suppliers). Where will you be getting your water for the temporary event? All foods, water, and ice must be purchased or obtained from an approved source. 2. Describe how and where all foods on the menu will be stored, prepared, transported, cooked, and served at the event. No extensive food preparation may be done onsite at the events. All foods prepared before the event must be prepared at a licensed facility or commissary and safely transported to the event for final assembly, cooking, and serving. Temperature Controlled for Safety Foods must be properly cooled and reheated. No home prepared food is permitted. Bare hand contact with ready to eat foods is prohibited. 3. List equipment and describe facilities that will be used at the temporary food establishment. All temporary food establishments must have adequate cooking, hot holding (>135F), and refrigeration facilities Thermometers must be available for food temperature checks and in all refrigerators and cold holding units. Temporary event establishment’s booth or set-up must be situated in a way that protects foods from environmental contamination (dust, debris, etc.). 4. Describe how hands will be washed. A handwashing facility or a portable handwashing station is required and must be present in the booth or temporary set-up. If must include a handwashing sink or warm water vessel (must have spigot that can be turned on and stay on for washing hands properly), soap, paper towels, and a catch basin or retention tank. 5. Describe how food contact surfaces and equipment will be cleaned and sanitized. Chlorine or quaternary ammonium based sanitizer must be present in the booth or temporary set-up. Appropriate test strips are required for checking sanitizer concentration. 6. How will wastewater and garbage be disposed? All wastewater and garbage must be disposed of at an approved site. Disposal on the ground or in a storm drain is prohibited. For more information on safe food handling practices please visit Central District Health’s website: PLEASE NOTE: Incomplete applications will delay review or result in the application not being approved. Please take the time to fill out the application completely. Do not reference information provided on previous applications you have made to Central District Health Department. I understand that the license is non-transferable and is based upon compliance with all food-handing regulations of the State of Idaho, determined on the basis of an inspection(s) by the local or state health authority and may be suspended for non-compliance with the Idaho Food Code. By signing, I testify that I have read, understand, and agree to comply with the above requirements during the temporary food establishment event; and I acknowledge receipt of the vendor’s packet detailing information for safe food handling. Applicant Signature: Print Name: **Please use reverse side of page for any additional information you would like to include with your application** f:\ehep\food\food forms\temp food event application rev 12-19.doc