HomeMy Public PortalAboutApplication Temp Food - Coffee,Pastry Permit Fill_202110040822390181Page 1 of 2
Larry Ramdin, MPH, REHS, CHO, CP-FS
Director of Public Health
TOWN OF WATERTOWN
Board of Health
Administration Building
149 Main Street
Watertown, MA 02472
Phone: 617-972-6446
Fax: 617-972-6499
www.watertown-ma.gov
APPLICATION FOR TEMPORARY FOOD – COFFEE & PASTRY PERMIT
Fee Amount: Coffee & Pastry $ 10.00
**Completed application must be received by Health Department at least
5 business days prior to event**
Applicant Information:
Name of Applicant:
Address of Applicant:
City: State: Zip Code:
Applicant Telephone #: Email:
Name of Business or Organization:
Telephone #: Fax #:
Business or Organization Mailing Address:
City: State: Zip Code:
Event Information:
Name of Event:
Event Location:
Event Location Address:
Date(s): Hours of Operation:
Estimated number of people to be served:
Food Information:
Source of Food: Name: Address:
List food to be served at event:
How is food transported to event to ensure food is protected from contamination?
Page 2 of 2
TEMPORARY FOOD – COFFEE & PASTRY PERMIT CONDITIONS
In order to ensure that safe and sanitary foods are served to the public, your Temporary Food –
Coffee & Pastry Permit is issued based on the following conditions:
Check-
Off
Temporary Food – Coffee & Pastry Permit Conditions
Your Temporary Food – Coffee & Pastry Permit must be conspicuously displayed on
site.
Only the food stipulated on your temporary food permit may be served.
Foods must be obtained from an approved commercial source (a grocery store). Proof
of source such as boxes, receipts, etc. must be on site.
All food items must be individually wrapped/packaged and labeled.
All foods and drinks shall be handled and stored in manner that prevents contamination
such as using clean covered containers at all times during display, storing equipment
and food up off the ground, protected from sunlight to prevent temperature elevation,
etc. Trash bags are not to be used for food storage.
Packaged and wrapped, ready-to-eat foods may not be stored directly in ice as it is
subject to the entry of water.
Single use Non-latex gloves or other approved protective equipment (tongs, deli tissue,
other utensils, etc.) must be used when handling ready-to-eat foods that are not
packaged. There shall be no bare-hand contact with foods that are ready-to-eat.
If using cups, hold cups at the bottom and do not touch the tops of the cups (where
people’s lips will go).
Dispose of garbage and rubbish generated from coffee & pastry service in a sanitary
manner, keep the premises clean.
No eating, drinking or smoking when serving ready-to-eat foods.
Avoid serving and handling foods if you are sick with vomiting, diarrhea, a cold, or if
you have been sick in the past 48 hours
I have read and understand the Temporary Food Service Event Conditions. I agree to abide by
them and understand that failure to do so will result in revocation of my Temporary Food –
Coffee & Pastry Permit.
X
Applicant’s Signature Date