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JIM GIBBONS Governor MICHAEL J. WILLDEN Director STATE OF NEVADA RICHARD WHITLEY, MS Administrator TRACEY D. GREEN, M.D. State Health Officer DEPARTMENT OF HUMAN RESOURCES HEALTH DIVISION Frontier and Rural Public Health Program Environmental Health Services TEMPORARY FOOD ESTABLISHMENT APPLICATION FOR SPECIAL EVENT This section for office use only: Permit Start Date: Permit Date Fees Paid: Number: Receipt Number: Date Permit Issued By: INCOMPLETE OR ILLEGIBLE APPLICATIONS MAY BE DENIED PLEASE TYPE OR PRINT CLEARLY THIS APPLICATION MUST BE COMPLETED AND FEES PAID AT LEAST 24 HOURS PRIOR TO THE START OF THE EVENT OR IT WILL NOT BE ISSUED FRONTIER AND RURAL HEALTH PROGRAM ENVIRONMENTAL HEALTH SERVICES FEE SCHEDULE (PLEASE MAKE CHECKS PAYABLE TO NSHD) FOR A TEMPORARY FOOD ESTABLISHMENT-PER UNIT : $50.00 FOR A TEMPORARY FOOD ESTABLISHMENT, WHICH IS OPERATED BY A RELIGIOUS, CHARITABLE OR OTHER NON-PROFIT ORGANIZATION, IF THE SALE OF FOOD FROM THE ESTABLISHMENT OCCURS OFF THE PREMISES OF THE ORGANIZATION: $25.00 NAME OF GROUP OR INDIVIDUAL APPLYING FOR THIS MAILING ADDRESS OF GROUP OR INDIVIDUAL APPLYING FOR THIS PERMIT: EVENT COORDINATOR NAME & PHONE NUMBER: ---PAGE BREAK--- SPECIAL EVENT AT WHICH TEMPORARY FOOD ESTABLISHMENT IS OPERATED: LOCATION AND ADDRESS OF EVENT: DATE(S) OF EVENT: HOURS OF EVENT: (Specify for each date if different) BOOTH OWNER OR OPERATOR: NAME: PHONE NUMBER: PERSON IN CHARGE OF BOOTH: EMAIL OF PERSON IN CHARGE: (If you are operating more than one booth, separate applications and fees are required) ANTICIPATED TIME OF SET UP OF FIRST DAY OF EVENT: ARE YOU SERVING FOODS THAT WILL BE PREPARED OFF-SITE? No IS THIS OFF-SITE LOCATION A PERMITTED FOOD ESTABLISHMENT? (Be advised that NAC Chapter 446 requires all food served to be prepared in a licensed food establishment. Be prepared to provide your inspector with a copy of the food establishment’s current health permit.) WHAT IF ANY FOODS ARE PREPARED OFF-SITE? LIST ALL OF THEM. SPECIFY IN DETAIL WHERE OFF-SITE FOODS ARE COMING FROM, THE DATE AND TIME YOU WILL PICK UP THOSE FOODS AND THE METHOD OF MAINTAINING BOTH HOT AND COLD TEMPERATURES DURING TRANSPORTATION TO THE EVENT. BE ADVISED THAT RECEIPTS FOR PROOF OF PURCHASE MAY BE REQUESTED AND MUST BE ON-SITE IF THE INSPECTOR REQUESTS TO SEE THEM. ---PAGE BREAK--- LIST ALL MENU ITEMS INCLUDING BEVERAGES YOU PLAN TO SERVE & DESCRIBE THE EQUIPMENT YOU PLAN TO USE. ATTACH ADDITIONAL PAGES IF NECESSARY. Food Item Served Source Off- Site Prep yes/no Cooking Equipment On Site Cold Holding Equipment On Site Hot Holding Equipment On Site BOOTH OWNER OR OPERATOR RESPONSIBILITIES: I UNDERSTAND THAT I AM RESPONSIBLE FOR COMPLYING WITH ALL APPLICABLE PROVISIONS OF N.A.C. CHAPTER 446, FOOD AND DRINK ESTABLISHMENTS. I HAVE RECEIVED A COPY OF THE TEMPORARY FOOD ESTABLISHMENT SELF-INSPECTION SHEET AND AGREE TO COMPLETE THE SELF-INSPECTION PRIOR TO MY HEALTH DIVISION INSPECTION AND RETAIN IT FOR MY INSPECTOR’S REVIEW. I UNDERSTAND THAT CRITICAL VIOLATIONS OF THE REQUIREMENTS OF NAC CHAPTER 446 MAY RESULT IN SUSPENSION OF MY PERMIT AND CLOSURE OF MY TEMPORARY FOOD ESTABLISHMENT. I UNDERSTAND THAT FAILURE TO FOLLOW THE MENU AS LISTED, PROPERLY EQUIP MY BOOTH AND HAVE MY BOOTH READY FOR INSPECTION, MAY RESULT IN CLOSURE. SIGNATURE DATE TEMPORARY FOOD ESTABLISHMENTS NAC 446.630 Applicable requirements; location of operation. 1. A temporary food establishment must comply with all the requirements of NAC 446.050 to 446.625, inclusive, which are applicable to its operation. ---PAGE BREAK--- 2. If, in the opinion of the health authority, an imminent hazard to the public health will not result, temporary food establishments which do not fully comply with all the requirements of NAC 446.050 to 446.625, inclusive, may operate when the preparation and service of food are restricted and deviations from full compliance are covered by the requirements set forth in NAC 446.635 to 446.660, inclusive. 3. A temporary food establishment may only be operated at a fair, carnival, circus, public exhibition, celebration or similar transitory gathering. The location from which a temporary food establishment is operated must be approved by the health authority. [Bd. of Health, Food Establishments Reg. Art. 17 § 17.1 subsec. 17.1.1 & § 17.2 subsec. 17.2.1, eff. 9-17-82]—(NAC A 9-16-92) NAC 446.635 Preparation and service of potentially hazardous food. 1. Potentially hazardous foods requiring limited preparation may be prepared or served at a temporary food establishment only if the health authority has approved the foods before their preparation and service. 2. This section does not apply to any potentially hazardous food that has been prepared and packaged under conditions meeting the requirements of NAC 446.045 to 446.195, inclusive, is obtained in individual servings, stored at a temperature of 40°F (4.44°C) or below or 140°F (60°C) or above in facilities meeting the requirements of NAC 446.045 to 446.195, inclusive, and is served directly in the unopened container in which it was packaged. 3. Potentially hazardous foods served at a temporary food establishment must be prepared and served in the same day and must not be saved for service on any following day. 4. Potentially hazardous food prepared in a private home must not be served in a temporary food establishment. [Bd. of Health, Food Establishments Reg. Art. 17 § 17.2 subsec. 17.2.2, eff. 9-17-82]—(NAC A 5-23-96) NAC 446.640 Ice. Ice which is intended for human consumption or which will come in contact with food or be used as a source of refrigeration must be obtained from an approved source. Ice intended for use in beverages must be manufactured in a chipped, crushed or cubed form. The ice must be obtained in plastic bags which are designed for a single use and are filled and sealed at the point of manufacture. The ice must remain in the bag until dispensed in a way that protects it from contamination. [Bd. of Health, Food Establishments Reg. Art. 17 § 17.2 subsec. 17.2.3, eff. 9-17-82]—(NAC A 5-23-96) NAC 446.645 Equipment and utensils. 1. Equipment must be located and installed in a way that prevents the contamination of food and that also facilitates cleaning. 2. Surfaces of equipment which come in contact with food must be protected from contamination by customers or other contaminating agents. If necessary, effective shields must be used. 3. If facilities for cleaning and sanitizing tableware are not effective, only articles intended for a single use may be used. [Bd. of Health, Food Establishments Reg. Art. 17 § 17.2 subsecs. 17.2.4-17.2.6, eff. 9-17-82] NAC 446.650 Facility for washing hands; potable water for preparation of food. 1. A convenient facility for washing hands which has: An adequate amount of warm, running, potable water from an approved source; Soap; and Individual paper towels, ---PAGE BREAK--- must be accessible and available for food handlers and other employees at all times. 2. An adequate supply of potable water from an approved source must be used to prepare food and operate the business. [Bd. of Health, Food Establishments Reg. Art. 17 § 17.2 subsecs. 17.2.7 & 17.2.8, eff. 9-17-82]—(NAC A 5-23-96) NAC 446.655 Floors, ceilings, doors and screening material. 1. If required by the health authority, floors must be constructed of concrete, asphalt, fitted wood or other similar cleanable material and must be kept in good repair. Dirt or gravel, when graded to drain, may be used as subflooring if it is covered with clean, removable platforms or duckboards. 2. Ceilings must be made of wood, canvas or other material that protects the interior of the establishment from the weather. The walls and ceilings of areas used for preparing food must be constructed so that insects are not present. 3. If required by the health authority, doors must be solid or screened and must close automatically. 4. Screening material used for walls, doors or windows must be at least 16 mesh to the inch. [Bd. of Health, Food Establishments Reg. Art. 17 § 17.2 subsecs. 17.2.9 & 17.2.10, eff. 9-17-82]—(NAC A 5-23-96) NAC 446.660 Service openings. 1. Service openings at the counter may not be larger than necessary for the particular operation conducted. 2. If required by the health authority, service openings must have solid or screened doors or windows which fit or must have fans. 3. Screened service openings in the counter must be kept closed except when in actual use. [Bd. of Health, Food Establishments Reg. Art. 17 § 17.2 subsec. 17.2.11, eff. 9-17-82]—(NAC A 5-23-96)