This form is for special event/market food vendors only. This application must be submitted 30 days prior to the event. Event Name * Event Location * Event Start Date * Year20192020202120222023 Year MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Event End Date * Year20192020202120222023 Year MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Event Start Time * Event End Time * Have you been inspected by the Windsor-Essex County Health Unit this year? * Yes No Specify which event(s) Food Vendor Information Booth Name * Name of Owner * Phone Number * Mailing Address of Owner * Email Address of Owner * Name of Operator * Operator Phone Number * Name of Contact (during event) * Contact Mobile * Food Service Information Certified Food Handler On-Site? * Yes No N/A (selling pre-package food) Note: As of July 1, 2018, there must be at least one food-handler/supervisor on the premises who has completed Food Handler Training, during the event. Copy of certificate must be available on-site Food Products Offered for Sale * Where will the food be prepared? Name of Food Premises * Address of Food Premises * Note: Special Events/Markets that are not exempt from the Food Premises Regulation will NOT be permitted to sell food prepared at an uninspected premise. Inspected kitchen may be a licensed business or a rented kitchen (e.g. church or community kitchen). Proof will be required (e.g. letter, inspection report, rental agreement). Type of food premises at event: (check all that apply) * Temporary Booth Drinking Water Hauler Mobile Catering Truck/Cart Other Other How will food be transported to event? (check all that apply) * Refrigerated Truck Coolers with Ice Thermal Unit (i.e.: cambro units) Insulated Container/Bag N/A Other Other How will temperature be maintained on site? (check all that apply) * Refrigerated Truck Insulated Container/Bag Thermal Unit (i.e.: cambro units) Coolers with Ice Chafing Dishes N/A Other Other Note: A probe thermometer must be available to verify proper internal food temperatures. Thermometers for cold storage units are also required. Which handwashing method will be used where food handling or preparation occurs on-site? * Portable Handwashing Station Container with Turn Spout Existing Handwashing Sink Other Other Which sanitizer will be used during event? * Chlorine (100ppm) Quat (200ppm) Iodine (25ppm) Note: Sanitizer test strips must be available on site. Means of Water Supply * Means of Dishwashing * Means of Waste Water Disposal * Floor and Roof Covering Material * Leave this field blank Submit
