Please complete and submit this application AT LEAST ten (10) business days prior to the start of the food service event. If the $30.00 fee is applicable to your event, please make checks payable to the University of Connecticut and send them to:

Environmental Health & Safety
3102 Horsebarn Hill Rd., Unit 4097
Storrs CT 06269-4097

Temporary Food Service Application

($30.00 fee applies to any event using an outside caterer)

Organization:
Name*:
Address*:

Event:
Name*:
Location*:
Date(s) & Time(s):
Est. # of Attendees*:
# of Food/Beverage Booths*:
Remarks:

Primary Contact Person for Food at Event (Coordinator):
Name*:
Phone*:
E-mail*:

Please Note: Prior to the event, each applicant must complete a brief food safety training on HUSKY CT VISTA. Please provide the information requested at the end of the form or call the EHS office at 486-3613 to sign up for training.:

1. What is the source of the food to be served/dispensed? Please list ALL food items! Help*
Important Notice The following information must be completed in its entirety and submitted to our office ten (10) business days prior to the proposed event. Applications received less than ten (10) business days may not be approved. If approved, all late temporary food service applications will be subject to the applicable late fee. Student organizations and University departments will be charged $10.00 per event. All non-University organizations will be charged $25.00 per event. Explanation of late fees. Please contact our office between 8:00am and 4:00pm Mon-Fri with any questions.

2. What food items will be served at the function? Please list ALL food items! Help*

3. How and where will the food items be kept cold/frozen? Help*

4. How and where will the food items be cooked? Help*

5. How will the hot food items be maintained? (A probe thermometer and alcohol swabs are required to check food temperatures. Time and temperature logs should also be kept) Help*

6. Describe the type of hand washing facility which will be used (Each booth must have one). Restrooms are not an acceptable substitute for a handwash station. Help*

7. How will food be protected during the event? (For example: Buffet food service lines must have sneeze guards or food container covers) Help*

8. Indicate the water source to be used for drinking, cooking, cleaning and hand washing (Water from home is not allowed). Help*

9. How and where will the service utensils be cleaned? (Properly washed, rinsed and sanitized.) Help*

10. Where will excess food and single service items be stored? Help*

11. Where will toxic items, such as cleaners, be stored? Help*

12. How will condiments and single service items be dispensed? Help*

13. What type of toilet facilities will be provided for the employees/public? How many? Help*

14. What method of garbage disposal will be used? Help*

15. Do you need to complete the Environmental Health & Safety online food safety training ?:
YesNo
If yes, please enter your NETID below so we can enroll you (ex. fst08001). If no, please identify the training course you have completed. Please Note: EH&S training is required yearly, prior to your event, unless you have attended food safety training.

I have read the University of Connecticut food safety guidelines & agree to all the applicable rules, regulations, and policies:
YesNo