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CHAPTER 1, FOOD SAFETY
Food Facility
Special Event Application
To Obtain a Permit to Operate a Food Concession or,
Operate a Temporary Food Establishment
Complete this application and submit to the Preventive Medicine Authority at least
30 days prior to the start of the event.
1.
Event:
2.
Location:
3.
Dates: (include set up)  event:
set up
4.
Name(s) of Sponsoring Organization and phone numbers.
5.
POC Name:
phone #
6.  List all foods to be served:
include where food will be prepared, who will
prepare the items:
Food
Prepared by/where
temperature holding method/equipment
(potentially hazardous food must be kept hot, 140F or cold, below 41F.)
7.  If potentially hazardous food is transported to the event, what is the length
of time in transport?
How will the food be transported?
How will the food be kept hot or cold?
8.
Food Source.
9.  Hand washing
facilities, including location in relation to food service and preparation:
Section below to be completed by the PMA
Approved
Disapproved
Signature:
Date:
Reason for Disapproval:
Special restrictions or requirements:
155


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