Student Organizations Portal - Temporary Food Permit Application

WSU Temporary Food Service Permit Application

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WSU Temporary Food Service Permit Application Form

Temporary Food Service is defined as: Limited to not more than 21 consecutive days of operation at a fixed location in conjunction with a single event or celebration.

1. Event Name:

2. Organiztion Name:

3. Applicant's Name: Phone:

4. Applicant's Address Street

City Zip

5. Proposed Location:

6. Beginning Date & Time (mm/dd/yyyy; 00:00am)

7. Ending Date & Time (mm/dd/yyyy; 00:00am)

8. Do you plan ADVANCED preparation?
If Yes, where?

9. Advanced prep. begins: (mm/dd/yyyy; 00:00am)

10. Advanced prep. ends: (mm/dd/yyyy; 00:00am)

Food Items to be Served	Off Site Prep Yes, or No?	On site Prep Yes, or No?	Cooking Procedures	Holding HOT or COLD?	Serving HOT or COLD?

NOTE: Late additions to the menu MUST be approved by the Health Department.

10. Cold Holding Equipment.:

11. Hot Holding Equipment.:

12. Cooking Equip.: Reheat Equip:

13. If food is transported to the food site, what is the length of time in transport?

14. How is food kept hot or cold during transport?

15. Have you made arrangments to keep a stem-type food thermometer available?
Note: Food thermometers can be checked out from Student Involvement CUB 320

16. What public water supply will be used:

17. How will waste water be disposed of?
Note: All hoses used in conjunction with water supply MUST be food grade material.

18. What hand washing facilities will be available?
Plumbed Sink Gravity Flow Container Hand Washing Station
Note: A handwashing station is available for check out through Student Involvement CUB 320

19. What utensil washing facilities will you use?

20. What sanitizing solution will you use? Bleach-Water Solution Other:

21. Garbage Disposal: Location of toilets:

IMPORTANT: The shift supervisor, and the person in charge of food preparation MUST Possess and have present, a valid Washington State food and beverage worker's permit. Do your shift supervisor, and food preparation supervisor both have a valid food and beverage workers permit?

Food and Beverage Worker's Permit Information

Name of Shift Supervisor	County of Issuance	Date of Expiration:
Name of Food Prep Supervisor	County of Issuance	Date of Expiration:

IMPORTANT: No bare hand contact of ready to be eaten foods permitted.

I hereby consent to inspection by WSU Environmental Health and Safety and acknowledge that issuance of this permit is contigent upon satisfactory compliance with local temporary food service requirements, a copy which I have received.

Applicant's Name Date:

For Administrative Purposes Only
Signature of authorizing Environmental Health and Safety Official:

Please type the letters below to submit the form:

Student Involvement and Leadership Development, Washington State University, Pullman WA 99164-7204, 509-335-9667 Contact Us