Method of Operation Application

Subpart 14-2 Temporary Food Service Establishments

Location of Temporary Food Service: Event Name*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Expected Opening Date
MM slash DD slash YYYY
Expected Closing Date
MM slash DD slash YYYY
Food To Be Served
Food To Be Obtained From
Types of Foods to be Prepared and Served
Describe How the Foods with be Prepared, and what Equipment will be Used for the Preparation
If Food is Prepared Offsite, Provide the Name, Address and Phone Number of the Approved Commercial Kitchen that will be Utilized
Note: Food preparation is not allowed in personal home kitchens.
How will the Food be Transported to the site
Ex: coolers with ice, cambro units etc.
Describe the Method of Food Service
Ex: will foods be cooked to order, held hot or cold during service period, self-serve by customer?
Describe the Equipment used to keep Foods Hot (at or above 140 degrees F)
How will the Foods be Dispensed and Handled
Note: utensils or plastic gloves must be used to prevent bare hand contact with food.
Describe the Construction of your Food Preparation Area
Describe the Hand Washing Station (at your concession) and Location of Toilets
What is the Source of Water Supply and Ice
How will Wastewater be Disposed of at the Site
Describe the Means of Refuse/Garbage Storage and Disposal

Special Note: All persons handling food are to be free from infectious disease which can be transmitted by foods and are not to have a boil, infected cut or sore, or infectious disease. They are to wear clean clothing, not smoke or use tobacco while handling food or in food preparation areas, and use hair restraints to minimize hair contact with hands, foods and food-contact surfaces. All personnel handling food are to was their hands with soap and water after using the toilet, smoking, eating or when soiled. The Department of Health reserves the right to limit the type of food to be served.

Please submit this form above or click here to download the form to fill out and return by email to Gia McCormack gmccormack@premiercaresfoundation.org or you may mail it to Gia McCormack at Premier Cares Foundation, P.O. Box 93, Pleasant Valley, NY 12569.