special event organizer notification form · special events food vendor form prior to the event,...
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Southwestern Public Health – Woodstock Site
410 Buller Street, Woodstock, ON N4S 4N2 Tel: 519-421-9901 Toll-free: 1-800-922-0096
Fax: 519-539-6206 Email: [email protected] dafsd
Amended June 2018
SPECIAL EVENT ORGANIZER NOTIFICATION FORM
MUST BE COMPLETED BY EVENT ORGANIZER AND RETURNED 20 DAYS PRIOR TO EVENT
Event Name:_________________________________ Annual/Repeat Event? ( )Yes ( )No
Location of Event:____________________________________________________________
Event Organizer Name:________________________ Telephone: ___________________
Email: _____________________________________
Contact Address: ____________________________________________________________
Event Dates & Times:_____________________ Setup Date & Time:__________________
Expected Attendance:_____________________ Is this a private party? Yes ( ) No ( )
Expected Number of Food Vendors: ___________
Event Organizer Questionnaire 1. Will there be a water supply available for vendors to use?
( ) Yes- Municipal water hookup( ) Yes- Hauled Water from:___________________________________________( ) Yes- Private Well (Attach most recent well water results)( ) No – Vendors will be responsible for their own water supply
2. Will there be waste water disposal available for vendors to use?( ) Yes- Septic System( ) Yes- Municipal System( ) Yes- Portable (Privy) Disposal Site( ) No- Vendors will be responsible for their own waste water disposal
3. Will there be garbage disposal for vendors and patrons to use?( ) Yes ( ) No
4. Will there be hand washing facilities available for patrons?( ) Yes- Portable hand wash stations( ) Yes- Permanent facilities (ie: municipal washroom facilities)( ) No – There will be alcohol-based hand rub available for patron use( ) No – Vendors will be responsible for their own patron hand wash facilities
5. Will there be washroom facilities available?( ) Yes –Portable washroom facilities( ) Yes – Fixed washroom facilities( ) No
6. Will there be electricity available for vendors to use?( ) Yes- with back- up generators in case of failure( ) Yes - with no back- up generators( ) No - vendors will be responsible for their own power generation
Southwestern Public Health – Woodstock Site
410 Buller Street, Woodstock, ON N4S 4N2
Tel: 519 539-9800 Toll-free: 1 800 755-0394 Fax: 519 539-6206
Email: [email protected] dafsd
Amended June 2018
7. Have you received your smoke-free fair/festival/special event package with applicable no-smoking signs?
( ) Yes - I have received the package and am aware of my obligations under the Smoke-Free Ontario Act
( ) Yes - I have received the package, but require more information
( ) No - I do not have a package, and would like to learn about my obligations under the SFOA
Please fill out the information in regards to any food vendors who will be attending your event. Please note that each vendor must submit an individual Special Events Food Vendor Form prior to the event, and must adhere to any agreed upon inspection times discussed with a Public Health Inspector. Note: an initial copy of the vendor list must be submitted 20 days prior to the event. In the chance that more vendors are added after the deadline, an update form may be submitted as needed to notify Southwester Public Health of any new food vendors who are attending the event. The event list can be altered up to 3 days prior to the event.
FOOD VENDORS
Name (Concession and Operator name)
Contact Info Type of Food
Address: Phone Number(s): E-mail:
Address: Phone Number(s): E-mail:
Address: Phone Number(s): E-mail:
Southwestern Public Health – Woodstock Site
410 Buller Street, Woodstock, ON N4S 4N2
Tel: 519 539-9800 Toll-free: 1 800 755-0394 Fax: 519 539-6206
Email: [email protected] dafsd
Amended June 2018
FOOD VENDORS
Name (Concession and Operator name)
Contact Info Type of Food
Address: Phone Number(s): E-mail:
Address: Phone Number(s): E-mail:
Address: Phone Number(s): E-mail:
Address: Phone Number(s): E-mail:
Address: Phone Number(s): E-mail:
Southwestern Public Health – Woodstock Site
410 Buller Street, Woodstock, ON N4S 4N2
Tel: 519 539-9800 Toll-free: 1 800 755-0394 Fax: 519 539-6206
Email: [email protected] dafsd
Amended June 2018
FOOD VENDORS
Name (Concession and Operator name)
Contact Info Type of Food
Address: Phone Number(s): E-mail:
Address: Phone Number(s): E-mail:
Address: Phone Number(s): E-mail:
Address: Phone Number(s): E-mail:
Address: Phone Number(s): E-mail: