Application And Notification For Community Events And Farmers Markets Form (Page 2 of 2) in pdf

Application And Notification For Community Events And Farmers Markets Form Page 2

1-800-563-2808

Multiple Event Participation Form

If you are attending more than one special event within North Bay Parry Sound District, please list the events below. Please note:

if you are serving the same foods as detailed above on the application, you do not need to submit an application for these events

you have specified below. If the food served/sold at another event is different please submit a new food vendor application

detailing the types of foods and source information. Attach additional pages if needed.

Name of the Event

Location of Event

Date of Event

Operating Hours

Proposed menu same

a.m./p.m.

as indicated below

(Yes/No)

 Yes

 No

 Yes

 No

 Yes

 No

 Yes

 No

 Yes

 No

For Public Health Inspectors’ Use Only:

The following conditions/recommendations are to be completed before the event is allowed to commence:

 Notice to Patrons sign provided for exempted vendors

 Foods Prepared in Uninspected Premises sign provided for exempted vendors

 Vendor Authorization sign provided for exempted and non-exempted vendors

 Donors of Potentially Hazardous Food List provided for exempted vendors

 Other approved resources. Specify:

For Internal Use Only:

 Non-exempted Community Event and Market (O.Reg. 562/90)

 Exempted Special Event (HPPA)

 Farmers Market (HPPA)

Specify actions taken:  consultations (telephone, fax, e-mail or in person). Please specify # _____

 inspection(s) completed: # _____

ENVIRONMENTAL HEALTH PROGRESS NOTES

EST./CLIENT NAME:

PREMISES:

DATE

TIME PUBLIC HEALTH INSPECTOR NOTES

INT

(YYYY/MM/DD)

MASTER SIGNATURE/DESIGNATION

INITIALS

Page Number



Check Here If Page

Following

EH-WIF-039-01

Page 2 of 2

NORTH BAY

681 Commercial Street, North Bay, ON P1B 4E7 • Tel: (705) 474-1400 / Fax: (705) 474-9481

PARRY SOUND

70 Joseph Street, Unit 302, Parry Sound, ON P2A 2G5 • Tel: (705) 746-5801

BURK’S FALLS

Application And Notification For Community Events And Farmers Markets Form Page 2

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