Special Event Form for Food Vendors

Please complete and submit this form at least 30 days prior to the event. Notifications may not be accepted/ reviewed after this time.

Mobile vendors already licenced by the local municipality and inspected by the Region of Waterloo Public Health are not required to submit a Special Event Vendor Form.

Event Details

Event name

Event location/address

Expected attendance

Event start date

Event end date

Is this an annual event? Is this an annual event?

Yes

Vendor Information

Vendor name/organization

Booth name

Contact name

Contact email address

Contact phone number

Extension

Type of set up at event (check all that apply) Type of set up at event (check all that apply)

Preparation/serving kitchen

Temporary booth/BBQ

Mobile vehicle (food truck)

Cart (hot dog or other)

Will a certified food handler be on-site? Will a certified food handler be on-site?

Yes

Food menu items

Please list what you will be serving at the event

Food menu item

Source of food/supplier

Location of food preparation

Add a menu item Remove this menu item

How will food be transported to the event (check all that apply) How will food be transported to the event (check all that apply)

Refrigeration

Thermal unit (cambro units)

Coolers with ice

Insulated container/bag

Food Safety Details

How are you keeping food cold and/or hot during the event (check all that apply) How are you keeping food cold and/or hot during the event (check all that apply)

Refrigeration/freezer

Chaffing dishes/steam table

Coolers with ice

Other

Thermal unit (cambro units)

How will food be reheated to a (minimum of 74°) prior to service?

A probe thermometer must be available on site to ensure proper internal food temperatures

Please describe your potable water source

Please ensure you have the following: potable water, liquid soap, paper towel, waste bucket.

Please describe your handwashing station set-up Please describe your handwashing station set-up

Fixed sink

Temporary hand wash station

Other

How will you ensure a clean supply of service utensils? (check all that apply) How will you ensure a clean supply of service utensils? (check all that apply)

Extra utensils

Cleaning and sanitizing dishes with a 2 compartment sink

Cleaning and sanitizing dishes with a 3 compartment sink

tables)? What method of sanitizing will you be using for utensils and/or food contact surfaces (ie. tables)?

QUAT

Bleach (1 tsp: 1 litre of water)

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Special Event Form for Food Vendors

Event Details

Vendor Information

Food menu items

Food Safety Details