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4vviFG3JGRWdGt4do5HGGm8XAs88FzuMizyYC2Cqx9EXdXBQaaQAKKXs3yBCAAmWTGdzFcckyXTPaJ7wtUddGp

Temporary Food Establishment - Vendor Application

Please complete the survey below to begin the process of obtaining a temporary food permit.

Thank you!

Name of Temporary Food Establishment

Name of Owner

Mailing Address

Email Address

Phone Number

Event Name

Event Name:

The event is not listed.

Please type in the name of the event.

Event Location

County where the event will be held.

* must provide value

Event Organizer's Name

Start Date

* must provide value

M-D-Y

End Date

* must provide value

M-D-Y

Will food preparation take place in a temporary booth?

Yes

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Booth Construction: briefly describe the flooring, walls/screening, and overhead protection of the food booth.

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Will the food preparation/service take place in a food truck, mobile unit, or pushcart?

* must provide value

Yes

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Is the Food Truck, Mobile Unit, or Push Cart currently permitted in the State of Tennessee?

* must provide value

Yes

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If you have an active food permit for this mobile unit, no temporary permit is required. You MUST have a copy of your current active Food Establishment permit and your most recent inspection posted on the Mobile Unit in order to be allowed to operate at the event. If you do not have these documents please contact us at geh.health@tn.gov for assistance or answer "no" to this question to proceed with applying for a temporary permit.

List the menu items (foods and drinks) to be prepared and served.

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Menu Items (foods and drinks) served- If more space is needed, upload additional foods/menu items that will be served.

Upload file

Do you agree that food workers will not be allowed to work if:
1) Ill with diarrhea or vomiting
2) Jaundiced (yellowed skin or eyes)
3) Diagnosed with an infection (Salmonella Typhi, Shigella, E. Coli, Hepatitis A Virus)
4) Experiencing sore throat with fever

Yes

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Who will be the Person(s) in Charge (PIC) responsible for safe and sanitary food preparation and service during the temporary event?

Check all of the equipment that will be used to prepare, store, or serve food.

Cooler/refrigerator

Freezer

Grill

Fryer

Deep fryer

Smoker

List the utensils and equipment that will be used to prepare and serve food.

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Utensils and equipment Items used- If more space is needed, upload additional utensil/equipment items that will be served.

Upload file

What type of sink/dishwasher will be used to wash, rinse, and sanitize equipment and utensils.

Commercial dishwasher

Three basin set-up in the temporary booth

Shared three-compartment sinks

Three-compartment sink within the temporary food establishment

None, only using clean, disposable utensils

NA, no utensils or equipment used in preparation and service

Other

If other, please explain.

What type of sanitizer will be used?

Chlorine

Quaternary Ammonia

Iodine

Other

If other, please explain,

Do you acknowledge that chemical test strips are required to verify the concentration of sanitizer solutions?

Yes

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Number of handwashing stations in the booth or mobile unit?

What type of handwashing facilities will be available/used in the food preparation and service areas?

Gravity-fed water with spigot and bucket to collect gray/wastewater

Self-contained portable handwashing unit with potable water and wastewater holding tanks

Plumbed sink(s) with hot and cold water under pressure

Other

If other type of handwashing sink, please explain

Will soap, paper towels, trash can, and signage posted stating "Wash Your Hands" be provided at all handwashing sinks?

Yes

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Will foods only be cooked to order and immediately served?

Yes

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Will any foods be prepared and held onsite for later service?

Yes

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If yes, list the foods that will be prepared and held onsite for later service.

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Describe what you will do with the prepared and/or cooked foods at the end of each day?

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Describe the source of all food supplies.

How will foods and supplies be transported to the event?

Responsible party for liquid waste removal/disposal?

Responsible party for solid waste removal?

Applicant Signature

Add signature

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