This form is for Farmers Market Food Vendors. Please complete and submit this form at least 30 days prior to the event. If you are an market organizer, please refer to our general Farmers’ Market page. Market Information This section is for information about which farmers market you are attending. Name of Market * Organizer Name * Please provide their full name. Market Business Phone * Market Email Address What type of market is it? * Seasonal Year Round If seasonal, what is the start date? Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202420252026 Your Business and Operator Information This section is for information about your business/operation. Business Name * Business Phone Number * Business Phone number Operator Name * Please provide your full name. Address * Street number and name City/Town * City/town Postal Code * Postal Code Email Address * Are you a farmer? * Yes No Home canning? * Yes No Are you an inspected facility? * Yes No If you are an inspected facility, please attach a copy of your last inspection report Files must be less than 2 MB.Allowed file types: pdf doc docx. Will a certified food handler be on site? * Yes No Food Source Information Please list the types of food you would like approval to sell at the market: Type of food*Source of ingredients*Address of food preparation*Edit Type of food * Source of ingredients * Address of food preparation * Safe Food Handling How will food be transported to the market (check all that apply) * Refrigerated Truck Thermal Unit Coolers or insulated bag with ice Other, specify: Transportation (other) How will temperature be maintained on site? * Refrigerated Truck Thermal Unit Coolers or insulated bag with ice Other, specify: Temperature (other) Will food samples be provided? * Yes No How will food be reheated (to a minimum of 74 degrees) prior to service? * What method will be used to protect food from contamination during display? * Food-grade wrap Sneeze guard Other, specify: Protection (other) Comments (Optional) Additional Comments 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. CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
