The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

c33td2MWdVLI4dYQXsATFtE7FL5zYAxsMWbws4WzatvAkeKBF6rGgLcSZHWvb2jd

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

reset

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

Expand

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

Yes

reset

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

Yes

reset

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.

Expand

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

reset

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.

Expand

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

reset

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

reset

Will foods only be cooked to order and immediately served?

Yes

reset

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

Yes

reset

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

Expand

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

Expand

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

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.