CITY OF NEW BEDFORD 2016 APPLICATION FOR TEMPORARY FOOD ESTABLISHMENT PERMIT Farmers Market - April-October Call (508) 991-6199 and ask for Mary Freire-Kellogg, Senior Food Sanitarian, if you have questions. Name of Establishment/Business Operator Contact Telephone/Email EVENT Name or LOCATION Date(s) of Event Hours of Operation Operator Mailing Address Before completing this application have you read the for Temporary Food Event Vendors?” ____Yes “Guidelines ____No If you are coordinating this event have you filled out the form entitled _____Yes “Checklist”? _____No 2) MENU: Attach a menu or list of all items to be prepared or served. Any changes to this list must be submitted and approved by the Health Department/Board of Health at least to the event. 7 days prior Name of person holding a 3) Certified Food Protection Manager with Allergen Awareness Training: _______________________________ (Please provide a copy of the certificates) 4) Will all foods be prepared at the Temporary Food Booth? ______ YES - Please fill out only SECTION B below. ______ NO - Please fill out SECTION A & B below. *Please attach a copy of the current food establishment permit for the commercial kitchen used. SECTION A - At the approved kitchen: List any potentially hazardous food item and for each item, check which preparation procedure will occur: FOOD: Cut/ Cook Cool Cold Reheat Hot Portion Thaw Assemble Hold Hold Pkg. 1) 2) 3) 4) 5) 6) SECTION B At the booth: – FOOD: Cut/ Cook Cool Cold Reheat Hot Portion Thaw Assemble Hold Hold Pkg.
CITY OF NEW BEDFORD 2016 APPLICATION FOR TEMPORARY FOOD ESTABLISHMENT PERMIT Farmers Market - April-October Call (508) 991-6199 and ask for Mary Freire-Kellogg, Senior Food Sanitarian, if you have questions. Name of Establishment/Business Operator Contact Telephone/Email EVENT Name or LOCATION Date(s) of Event Hours of Operation Operator Mailing Address Before completing this application have you read the “Guidelines for Temporary Food Event Vendors?” ____Yes ____No If you are coordinating this event have you filled out the form entitled “Checklist”? _____Yes _____No 2) MENU: Attach a menu or list of all items to be prepared or served. Any changes to this list must be submitted and approved by the Health Department/Board of Health at least 7 days prior to the event. 3) Name of person holding a Certified Food Protection Manager with Allergen Awareness Training: _______________________________ (Please provide a copy of the certificates) 4) Will all foods be prepared at the Temporary Food Booth? ______ YES - Please fill out only SECTION B below. ______ NO - Please fill out SECTION A & B below. *Please attach a copy of the current food establishment permit for the commercial kitchen used. SECTION A - At the approved kitchen: List any potentially hazardous food item and for each item, check which preparation procedure will occur: FOOD: Thaw Cut/ Assemble Cook Cool Cold Hold Reheat Hot Hold Portion Pkg. 1) 2) 3) 4) 5) 6) SECTION B – At the booth: FOOD: Thaw Cut/ Assemble Cook Cool Cold Hold Reheat Hot Hold Portion Pkg.
NBFMTempFoodPermitwithFAQ.docx