This form is for Special Event Food Vendors. Please complete and submit this form at least 14 days prior to your first event. For more information for event organizers and vendors, please refer to the Special Events page. 2023 Application Is this your first application in 2023 at WDG? * Yes No Has anything changed from your last application? Yes No Please continue with the application. Please submit New Information Form instead. Vendor Information Business Name * Contact Name * Contact Business Phone * Contact Email Address * Business Address * Website Event InformationPlease add all events known/booked for 2023 in the Wellington, Dufferin and Guelph region. Event NameEvent Location / AddressStart Date Duration (# of Days)Organizer NameOrganizer Contact (phone/email) Event Name Event Location / Address Start Date Month JanFebMarAprMayJunJulAugSepOctNovDec Day 12345678910111213141516171819202122232425262728293031 Year 1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Duration (# of Days) Organizer Name Organizer Contact (phone/email) Food Handling Information Food Preparation Are you an inspected facility? * Yes No Vendor Set-up: * food booth/tent Hot dog cart Mobile food premise Indoor facility Outdoor Food preparation location: * On-site Off-site If location is off-site, please include Name of premise, address, phone number How many certified food handlers will be on-site? * Number (enter in text field below) Not applicable (explain below) Number: Not applicable - please explain: Will there be sampling? * Yes No MENU ITEMS Add each food menu item to the chart below. Items can be grouped (i.e. tacos). Menu ItemType of Cooking (e.g., grilling, frying, etc.)Food pre-cookedFood cooked on-siteWhich Event(s) Menu Item Type of Cooking (e.g., grilling, frying, etc.) Food pre-cooked SelectYesNoNot applicable Food cooked on-site SelectYesNo Which Event(s) FOOD SUPPLIERS Example: Burgers, Costco, Guelph, Ontario Type of Food ProductNameAddress Type of Food Product Name Address FOOD STORAGE / TRANSPORTATION How will foods be transported to the event? * Insulated container with ice/ice packs Refrigerated truck Insulated container for hot foods Other, please specify Other: What method(s) will be used to maintain cold foods 4°C (40°F) or colder during the event? * Not applicable Mechanical refrigeration Refrigerated truck Coolers, with ice packs and/or ice Other, please specify Other: What method(s) will be used to maintain hot foods at 60°C (140°F) or hotter during the event? * Not applicable Chafing dish Sternos Electric hot holding unit Steam table Oven Other, please specify Other: What method(s) will be used to re-heat food prior to service? * Not applicable Microwave oven Stove top Oven Deep fryer Grill/BBQ Other, please specify Other: Will a probe thermometer be available to check the internal temperatures of all hazardous foods? * Yes No A probe thermometer is required if cooking, re-heating, or hot-holding hazardous food products. Will an indicating thermometer be in all cold storage units to verify temperatures? * Yes No An indicating thermometer is required if hazardous food items are stored in cold storage units. This is required to ensure proper temperatures are maintained. How will the food products be protected from contamination while on display? * Not applicable Food-grade wrap Lid Pre-packaged condiments Sneeze guard/shield Enclosed cabinet/container Other, please specify Other: HANDWASHING Will you have a separate hand-washing station located in the food handling/ food preparation area with free-flowing water and fully equipped (soap in a dispenser, paper towels, wastewater collection)? * Yes No, please explain Explanation: CLEANING/SANITIZING Will you have hot and cold running water in the booth/truck with a minimum two-compartment sink for utensil washing? * Yes No There will be no running water at booth. Utensil washing will be done using three basins (wash, rinse, sanitize). Yes No Do you have a heat source to provide hot water for dishwashing (electric coffee urn/kettle etc.)? Yes No There will be no utensil washing onsite. Extra clean utensils will be provided onsite for use throughout the day. Yes Pre-packaged products only What sanitizer will be used for dishwashing and surface sanitizing? * Chlorine bleach QUAT Iodine Other, please specify Other: Will you have test strips to verify your sanitizer concentration? * Yes Other, please specify Other: WASTE DISPOSAL Will you have durable water and rodent-proof garbage bins to store food waste until disposal? * Yes Other, please specify Other: How will you be collecting and storing wastewater at the event? * Not applicable (no water used) Dedicated grey water tank installed in mobile food premise vehicle Other, please specify Other: Additional information Upload last inspection report Files must be less than 2 MB.Allowed file types: jpg jpeg png pdf doc docx. Upload floor plan Files must be less than 2 MB.Allowed file types: jpg jpeg png pdf doc docx. Upload Certified Food Handler Certificate Files must be less than 2 MB.Allowed file types: jpg jpeg png pdf doc docx. Attachments can be emailed to PHI.Intake@wdgpublichealth.ca if you are experiencing issues uploading files. Any other comments (optional) The information on this form is collected under the authority of the Health Protection and Promotion Act in accordance with the Municipal Freedom of Information and Protection of Privacy Act and the Personal Health Information Protection Act. This information will be used for the delivery of public health programs and services; the administration of the agency; and the maintenance of healthcare databases, registries and related research, in compliance with legal and regulatory requirements. Any questions about the collection of this information should be addressed to the Chief Privacy Officer at 1-800-265-7293 ext 2975.