Event Form

Kandiyohi-Renville
Community Health Board

E-APPLICATION AND LICENSING

Developed By CPT

Ver 11/13/2023

Kandiyohi-Renville Community Health Board
2200 23^rd Street NE Suite 1080, Willmar, MN 56201
www.co.kandiyohi.mn.us — www.co.renville.mn.us
Kandiyohi County: 320.231.7800
Renville County: 320.523.2570
publichealth@co.kandiyohi.mn.us — rcph@renvillecountymn.com

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2024 Special Event Food Stand Application

Applications should be submitted two weeks in advance of the event

Name of Event:

Location of Event:

City: State:

Zip:

Dates of event: From: To:

Time of food stand operation:
From: To:

Applicant's Information:

Name (individual or business):

Mailing Address:

City: State:

Zip:

Telephone: Email:

Preferred method of receiving permit: Email Mail Pick-Up

Mailing address if different than above:

Mailing Address

City: State:

Zip:

Will there be dish and utensil washing on site? Yes No

If yes, what kind of facilities will be provided and what sanitizing method (mechanical/chemical) will be used?

Will food be prepared day of event? Yes No

If no, when will food be prepared?

Will food be prepared at location of event? Yes No

If no, where will food be prepared?

Will single service gloves be used: Yes No

Is there a handwash sink on site? Yes No

If no, will water cooler and soap be used? Yes No

Non-Refundable Application Fee:
$20 per day the event is held Total Fee: $
**A late fee of $20 is due for any applications received less than four days prior to the event
An applicant's operating dates may not exceed 10 total days annually.

Make checks payable to: Kandiyohi-Renville Community Health Board

Food/Beverage Item Source
Grocery, deli, etc. Cold Storage Method
Refrigerator, dry ice, cooler, etc.
Mechanical refrigeration is required for events of 4 hours or longer. Food Preparation Equipment
gas grill, range, etc. Hot Food Holding Equipment
roasters, etc.
NO CROCK POTS

THIS APPLICATION IS APPROVED ONLY FOR OPERATION AS SPECIFIED ABOVE; ADDITIONAL APPROVAL IS REQUIRED FOR ANY CHANGES.

Drop files here to upload
If form needs resubmission all files will be saved, but not shown
except in the case of session expiration

This is to certify that I am the individual who is the subject/business owner of the requested application.

This statement is to certify that all of the information in this application is true and correct and has been provided by the above named subject/business owner.
I certify that the information provided on this application is accurate and complete.

Online Application Completed
ByDate

SPECIAL EVENT FOOD STAND GUIDELINES

Hand washing. If a hand washing sink is not located on site you must provide a hand washing facility. You can use a water cooler with a spigot placed on top of a table, with a bucket on the ground to catch waste water. Also provide soap and paper towels.

Hand washing. Food service workers need to wash their hands before preparing or serving food; at the start of their shift, after handling raw meat, after handling soiled items or cleaning, after taking a break, after eating or smoking, and after using the restroom.

Health & Hygiene. People that are ill with diarrhea or vomiting are not allowed to work in the food service operation. No one with cuts, burns, or other skin abrasions should be allowed to handle food.

Cooking. Use a food thermometer to check on cooking temperatures. Foods need to be cooked to 165 degrees F.

Thermometer. A thermometer must be provided to take food temperatures.

Cold Holding. Foods that require refrigeration must be held at 41 degrees F. or below. Mechanical refrigeration is required.

Hot Holding. Once the food is cooked to the proper temperature it must be held at 140 degrees F. or above. Crockpots are not allowed.

Food Handling. Bare hand contact with food is not permitted. All people handling food must wear disposable gloves. Use disposable gloves, tongs, napkins, or other utensils to handle food. Hands must still be washed when using gloves or other serving utensils.

Food Preparation. All food preparation must be completed on site. Food can not be prepared at home. Food must be prepared on the day of the event, unless it is prepared by a licensed food establishment such as a restaurant, grocery store, or caterer.

Ice. Ice used to cool cans and bottles should not be used in cup beverages. Ice for cups should be stored separately and be dispensed with a scoop not with hands.

Wiping cloths. Rinse and store your wiping cloths in a bucket of sanitizer (1 capful of bleach in 1 gallon of water). Change the solution every two hours.

Dish Washing. Wash cooking equipment and utensils in a 4-step sanitizing process: 1) washing in hot soapy water, 2) rinsing in hot water, 3) sanitizing in a solution of 1 capful of bleach and 1 gallon of water, 4) air drying.