Consumer Health - Food Services

Neighborhood Services > Health Services

Temporary Food Establishment Permit Application

Name of Event:

Date(s) of Event:

Hours of Operation:

From to

Location of Event (Address):

Time of Inspection (at least 30 minutes prior to projected time of food services): *

*ALL REQUIREMENTS ON EVENT CHECKLIST MUST BE MET PRIOR TO THE TIME OF INSPECTION.

Organization:

Responsible Person:

Address:

CELL Phone:

(We *must* be able to contact you directly the day of the event with questions or issues regarding the event.)

Do you operate food establishments at other location? Yes No
Location:

1. Will you be handling raw meat? Yes No
If Yes, how will it be prepared and stored?

2. Food Items to be Served	Food Preparation Method and Equipment

3. Food Purchased (store/location):

4. Location of commercial kitchen/permitted food preparation/storage site:

5. Hand was set up (required: stocked sink (not a restroom) or 5 gallon of igloo cooler with a spigot filled with hot water; pump soap; paper towels, catch bucket):

5. 3 Bucket Dish was set up (required; (1)bucket hot, soapy water; (1) bucket clear water; (1) bucket sanitizer water [1 teaspoon bleach + 1 gallon water]):

***Hand wash stations(cambros), hot holding equipment (warmers) may be borrowed from Consumer Health at a first come, first serve basis. Each piece of equipment requires a $100 deposit and must be returned within 5 days after the event. Equipment may be reserved prior to the event. Call (817)427-6650 to reserve equipment.

6. Equipment Needed (#):
Cambro(s) for hand washing Warmer(s) for holding food hot

*NO FOOD MAY BE SERVED UNTIL AN INSPECTION IS PERFORMED AND A PERMIT ISSUED. *CHILDREN UNDER 16 YEARS OF AGE MAY NOT SERVE FOOD OR DRINKS AT TEMPORARY EVENTS. *CROCK POTS, STERNO, AND BBQ SMOKERS ARE NOT ALLOWED. *HAIR RESTRAINTS REQUIRED. *HOME-PREPARED FOOD MAY NEVER BE SOLD, SERVED, OR OFFERED TO THE PUBLIC.

Applicant Signature:

Date:

Neighborhood Svcs Rep:

Date:

7200 C Dick Fisher South * North Richland Hills, Texas * 76180
817-427-6650 * FAX 817-427-6656