Food and Drug Administration and Conference for Food Protection

PRE-OPERATIONAL GUIDE FOR TEMPORARY FOOD ESTABLISHMENTS
2000

Application for Temporary Food
Establishment Permit

Table of Contents

Regulatory Authority

[Address]

[Phone #]


APPLICATION FOR TEMPORARY FOOD ESTABLISHMENT PERMIT

Directions:
The operator of each TFE Site must complete this application. The application must be completed and submitted to the regulatory authority at least 14 days before an event involving 5 or fewer booths, and 30 days prior to an event involving more than 5 food booths.

In addition, using the attached Sketch Sheets, each operator must provide:

Date of Submission

Name of Temporary Food Establishment:


Name of Operator/Owner:

Mailing Address:

Telephone Number:

Name of Event:

Date(s) and Time(s) of Event:

Date and Time TFE will be set up and ready for inspection:

  1. List all food and beverage items to be prepared and served. Attach a separate sheet if necessary. (NOTE: Any changes to the menu must be submitted to and approved by the Regulatory Authority at least 10 days prior to the event.)



  2. Will All Foods Be Prepared At The TFE Site?
    _____Yes>>Complete Attachment A
    _____No >>Complete Attachments A & B

    If No, the operator Must provide a copy of the current license for the permanent food establishment where the food will be prepared.

  3. Describe (be specific) how frozen, cold, and hot foods will be transported to the Temporary Food Establishment:



  1. a) How will food temperatures be monitored during the event?


  2. Identify the sources for each meat, poultry, seafood, and shellfish item. Include the source of the ice:



  3. Using Attachment C, record the names, phone numbers, shifts to be worked during the event and the assigned duties of all Temporary Food Establishment workers (paid and volunteer).

  4. Describe the number, location and set up of handwashing facilities to be used by the Temporary Food Establishment workers:



  5. Identify the source of the potable water supply and describe how water will be stored and distributed at the Temporary Food Event. If a non-public water supply is to be used, provide the results of the most recent water tests.



  6. Describe where utensil washing will take place. If no facilities are available on site, describe the location of back-up utensil storage.



  7. a) Describe how and where wastewater from handwashing and utensil washing will be collected, stored and disposed:




    b) If portable toilets are to be used, identify the frequency of waste removal:



  8. Describe the number, location and types of garbage disposal containers at the Temporary Food Establishment as well as at the event site:



  9. Describe the floors, walls and ceiling surfaces, and lighting within the Temporary Food Establishment:



  10. Describe how electricity will be provided to the Temporary Food Establishment:



  11. Please add any additional information about your Temporary Food Establishment that should be considered:















    **************


    Statement: I hereby certify that the above information is correct, and I fully understand that any deviation from the above without prior permission from the Regulatory Office may nullify final approval.

    Signature(s)

    Date: _______________

    Approval of these plans and specifications by this Regulatory Authority does not indicate compliance with any other code, law or regulation that may be required (i.e., federal, state, or local). Furthermore, it does not constitute endorsement or acceptance of the completed establishment (structure or equipment). A preopening inspection of the establishment with equipment in place and operational will be necessary to determine if it complies with the local and state laws governing food service establishments.

    Regulatory Authority:

    APPROVAL: ________________ DATE: __________

    Permit Restrictions:


    Permit Effective Dates:

    DISAPPROVAL: ________________ DATE: __________

    Reason(s) for Disapproval:






    Reviewer Signature & Title


    Date: __________


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