Required fields are marked with asterisks (*)

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 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?

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)

Preparation/serving kitchen

Temporary booth/BBQ

Mobile vehicle (food truck)

Cart (hot dog or other)

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)

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)

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

Fixed sink

Temporary hand wash station

Other

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

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)

If you are a vendor from outside of Waterloo Region, attach your last food safety inspection report, from your health unit.

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