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Special Event Food Vendor Application Form

The completed form must be submitted to Renfrew County and District Health Unit ten (10) business days before the event. Call us at 613-732-3629 extension 505 if you have any questions.

If seeking exempt status, ensure the form is filled out by a member of the exempt organization (service club, fraternal organization, religious group) making the application.

The food concession is prohibited from operating until approval is granted.

The personal information on this form is collected under the authority of the Health Protection and Promotion Act and will be used for the administration of Public Health programs. Any questions about the collection of this information should be directed to the Manager of Environmental Health, Renfrew County and District Health Unit, 141 Lake St. Pembroke Ontario K8A 5L8, 613-732-3629 extension 505.

"*" indicates required fields

Date of Event*
Time of Event*
:
Location of Event*
Contact Person for Event*
Mailing Address

Food Vendor Information

Who Will Be Preparing Food?
Name
Phone
 
Is the Location Where Food Prepared an Inspected Business?
Certified Food Handler Present During Food Preparation?
How Will Cold Food be Kept Cold?
How Will Hot Food be Kept Hot?

All hazardous food (dairy products, eggs, meat, poultry, fish, seafood, cooked grains, vegetables and legumes) must be kept cold (4°C or lower) or hot (60°C or higher)

What Hand Washing Facilities Are Available For Use At Event?
Note: These cannot be washroom or dishwashing sinks. Hand sanitizer alone is inadequate.
Where Will Dishes Be Washed?
*excluding hand wash sink
Type of Utensils Used by the Public For Food Service At Event
Will There Be Free Food Samples Provided?
By submitting this form, I acknowledge I have read, understand, and agree that the information provided in this form is correct.

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Pembroke Office

141 Lake Street, Pembroke, Ontario K8A 5L8

Phone: 613-732-3629
Toll Free: 1-800-267-1097
Fax: 613-735-3067

Hours of Operation
Monday to Friday, 8 a.m. - 4 p.m.

Renfrew Service Hub (By Appointment Only)

120 Plaunt Street South, Renfrew, Ontario, K7V 1M5

Services offered by appointment only.

If you require an alternative accessible format or assistance accessing information on this page, please contact us at contact@rcdhu.com or 613-732-3629.