Blank Temporary Food Permit Hawaii PDF Form

Blank Temporary Food Permit Hawaii PDF Form

The Temporary Food Permit Hawaii form is a necessary application for organizations or individuals looking to sell food at events for a limited time. This permit ensures that food distribution meets health and safety standards set by the Department of Health. To get started, fill out the form by clicking the button below.

When planning a temporary food event in Hawaii, obtaining a Temporary Food Permit is essential. This application form serves as the gateway for organizations and individuals looking to sell or distribute food to the public for a limited time. The form requires specific details, such as the name of the organization, the event's location, and the contact person's information. Additionally, applicants must provide the date and time of the event, as well as the name and address of an approved commercial kitchen where food preparation will take place. It's important to note that home kitchens cannot be used for this purpose. The application also mandates a list of food items to be served, ensuring that no home-prepared food is included. Along with the application, a $25 non-refundable fee is required, and submissions should be made at least ten working days before the event. The Department of Health reserves the right to deny or revoke permits if sanitary requirements are not met. By following these guidelines, applicants can help ensure a smooth process for their temporary food establishment.

Document Sample

SANITATION BRANCH

 

 

 

 

 

 

 

 

 

 

 

STATE OF HAWAII

54 HIGH STREET, ROOM 300

 

 

 

 

 

 

 

 

 

 

 

DEPARTMENT OF HEALTH

WAILUKU, HAWAII 96793

 

 

 

 

 

 

 

 

 

 

 

 

 

TELEPHONE NUMBER: (808) 984-8230 FAX: (808) 984-8237

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPLICATION FOR TEMPORARY FOOD ESTABLISHMENT PERMIT

 

 

 

 

 

(Please type or print in black or blue ink)

 

 

 

 

(A)

NAME OF ORGANIZATION OR ESTABLISHMENT

 

(B)

LOCATION OR ADDRESS OF EVENT (ONLY ONE) Whale Day Celebration

 

 

 

 

 

 

 

 

 

Kalama Park: 1900 S. Kihei Road, Kihei, HI 96753

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(C)

CONTACT PERSON

 

 

 

(D)

CONTACT PERSON PHONE #

FAX PHONE #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DAY

 

(E) DATE OF EVENT

(F) TIME OF EVENT

 

DAY

(E) DATE OF EVENT

 

(F) TIME OF EVENT

1.

 

 

2/21/2009

9:00 a.m. - 5:30 p.m.

11.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

 

 

 

 

 

 

12.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

 

 

 

 

 

 

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4.

 

 

 

 

 

 

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5.

 

 

 

 

 

 

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6.

 

 

 

 

 

 

16.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

 

 

 

 

 

 

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8.

 

 

 

 

 

 

18.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9.

 

 

 

 

 

 

19.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10.

 

 

 

 

 

 

20.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(G) NAME OF APPROVED KITCHEN (COMMISSARY)

(H) STREET ADDRESS OF KITCHEN

 

 

(I) PERMIT NO.

 

 

 

 

 

 

 

 

 

 

 

 

 

KITCHEN USE AUTHORIZED BY: (J) (OR ATTACH LETTER OF AUTHORIZATION)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(K) SIGNATURE OF AUTHORIZED PERSON

 

 

 

 

 

 

(L) KITCHEN PHONE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(M) PRINT NAME OF AUTHORIZED PERSON

 

 

 

 

 

 

(N) TITLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(O)

LIST FOOD ITEMS. NO HOME PREPARED FOOD.

REMINDER: KEEP HOT FOOD ABOVE 140° F. KEEP COLD FOOD BELOW 45 °F.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(CONTINUE FOOD ITEMS ON A SEPARATE PAPER IF NEEDED)

(P) ATTACH: SITE PLAN – INCLUDE HAND WASHING FACILITIES, BOOTH LAYOUT

The Sanitation Branch, Department of Health reserves the right to deny your Temporary Food Establishment Permit or revoke the permit for failure to comply with the sanitary requirements of Hawaii Administrative Rules, Title 11, Department of Health, Chapter 12, Food Establishment Sanitation. The permit applicant may be required to submit a complete menu and schematic plan of the proposed operation.

THIS PERMIT IS ONLY VALID FOR TWENTY (20) DATES IN ANY 120 DAY PERIOD

 

(Q) DATE

(R) SIGNATURE OF APPLICANT

 

 

 

 

 

 

(S) TITLE

(T) PRINT NAME OF APPLICANT

FEE $25.00 NON REFUNDABLE

SUBMIT APPLICATION AND FEE AT LEAST TEN WORKING DAYS PRIOR TO EVENT

MAKE CHECKS PAYABLE TO:

STATE OF HAWAII

(BANK ACCOUNT NAME AND ADDRESS MUST BE ON THE CHECK)

SUBMIT COMPLETED APPLICATION AND FEE TO:

 

SANITATION BRANCH

 

 

 

 

 

54 HIGH STREET, RM. 300

 

 

 

 

 

WAILUKU, HI 96793

THERE WILL BE A SERVICE FEE OF $25.00 FOR ANY CHECK DISHONORED BY THE BANK.

APPROVED:

DATE

SIGNATURE OF AGENT/DEPARTMENT OF HEALTH

R.S. LIC. NO.

Department of Health Seal

 

SECTION BELOW FOR OFFICIAL HEALTH DEPARTMENT USE ONLY

 

FEE

$25.00

DATE PAID

METHOD OF PAYMENT

RECEIPT NO.

RECEIVED BY

SAN APP TFE MAUI 11/07

INSTRUCTIONS FOR

TEMPORARY FOOD PERMIT APPLICATIONS

All establishments, organizations, or individuals distributing or selling food to the public for a limited period of time (not exceeding 20 dates within a 120 day period) are required to submit a Temporary Food Establishment Permit Application to the Department of Health, Sanitation Branch. Applications will not be processed if the form is incomplete.

Applications and $25.00 fee should be submitted at least ten (10) working days prior to event.

All exemptions will be decided by the Department of Health Sanitation Branch.

Approved permit may be picked-up OR faxed OR mailed to you (include a self-addressed, stamped envelope with the application).

A.NAME OF ORGANIZATION OR ESTABLISHMENT: Name of organization or establishment administering the food operation. Each permit applies to one (1) organization or establishment only.

B.LOCATION OR ADDRESS OF EVENT: Site of food distribution. Each permit applies to one (1) location.

C.CONTACT PERSON: Name of person(s) representing the organization or establishment.

D.CONTACT PHONE OR FAX NUMBER: Phone number of person(s) representing the organization or establishment.

E.DATE OF EVENT: One date per line (Maximum of 20 dates within a 120 day period, starting from the date of the first event).

F.TIME OF EVENT: Start to end time of event.

G.NAME OF APPROVED KITCHEN (COMMISSARY): Name of approved commercial kitchen (commissary) where food preparation, food storage, utensil washing, etc. will be done.

The proposed approved kitchen (commissary) must still be approved by the Department of Health for the temporary food event. Home kitchens are not acceptable for use.

H.STREET ADDRESS OF KITCHEN: Street address of approved commercial kitchen (commissary) where food preparation, food storage, utensil washing, etc. will be done.

I.PERMIT NO.*: Permit number of the approved commercial kitchen (commissary) where food preparation, food storage, utensil washing, etc. will be done.

*Permit number issued by the State Department of Health.

J.(OR ATTACH LETTER OF AUTHORIZATION): Instead of having the Authorized Person sign the application, a letter of authorization from the person in charge of the kitchen may be submitted which must include information G, H, I, K, L, M, and N.

K.SIGNATURE OF AUTHORIZED PERSON: Signature of person giving permission to use the approved commercial kitchen (commissary).

L.KITCHEN PHONE NUMBER: Phone number of approved commercial kitchen (commissary).

M.PRINT NAME OF AUTHORIZED PERSON: Print name of “(K) Signature of Authorized Person.”

N.TITLE: Title of “(K) Signature of Authorized Person.”

O.LIST OF FOOD ITEMS: All food and drink items being sold or distributed at the event (in the case of “BBQ” chicken sales, include the number of pieces of half or whole chickens to be sold).

P.SITE PLAN, BOOTH LAYOUT: On a separate paper draw a site plan and indicate the booth where food will be distributed including handwashing facilities, warmers, burners, cookers, etc.

Q.DATE: Date submitting application.

R.SIGNATURE OF APPLICANT: (Applicant and contact person need not be the same person).

S.TITLE: Title of “(R) Signature of Applicant.”

T.PRINT NAME OF APPLICANT: Print name of “(R) Signature of Applicant.”

File Specifics

Fact Name Details
Governing Laws The Temporary Food Permit is governed by Hawaii Administrative Rules, Title 11, Chapter 12, which outlines food establishment sanitation requirements.
Application Fee A non-refundable fee of $25.00 is required upon submission of the application for the Temporary Food Establishment Permit.
Validity Period This permit is valid for a maximum of twenty (20) dates within any 120-day period, beginning from the date of the first event.
Submission Deadline Applications must be submitted at least ten (10) working days prior to the event to ensure processing and approval.

How to Use Temporary Food Permit Hawaii

Completing the Temporary Food Permit Hawaii form is essential for those planning to sell or distribute food at events in Hawaii. Once you have filled out the form correctly, you can submit it along with the required fee to the appropriate department. Make sure to follow the guidelines closely to avoid any delays in processing your application.

  1. Gather Required Information: Collect all necessary details about your organization, event, and food items.
  2. Complete Organization Details: Fill in the name of your organization or establishment in section (A).
  3. Event Location: Enter the address of the event in section (B). Only one location is allowed per application.
  4. Contact Person: Provide the name of the contact person in section (C).
  5. Contact Information: Fill in the contact person's phone number and fax number in section (D).
  6. Event Date: List the date(s) of your event in section (E). Remember, you can include up to 20 dates within a 120-day period.
  7. Event Time: Specify the start and end time of the event in section (F).
  8. Approved Kitchen Information: Enter the name of the approved kitchen (commissary) in section (G).
  9. Kitchen Address: Provide the street address of the approved kitchen in section (H).
  10. Kitchen Permit Number: Fill in the permit number for the kitchen in section (I).
  11. Authorization: If applicable, include a letter of authorization instead of a signature in section (J).
  12. Authorized Person Signature: Have the authorized person sign in section (K).
  13. Kitchen Phone Number: Enter the phone number of the approved kitchen in section (L).
  14. Print Authorized Person's Name: Print the name of the authorized person in section (M).
  15. Title of Authorized Person: Indicate the title of the authorized person in section (N).
  16. List Food Items: Clearly list all food items being sold in section (O). No home-prepared food is allowed.
  17. Attach Site Plan: Draw and attach a site plan that includes the booth layout and handwashing facilities in section (P).
  18. Application Date: Write the date you are submitting the application in section (Q).
  19. Applicant Signature: Sign the application in section (R).
  20. Applicant Title: Provide your title in section (S).
  21. Print Applicant's Name: Print your name in section (T).
  22. Submit Application: Send the completed application and the non-refundable fee of $25 to the Sanitation Branch at the provided address.

Your Questions, Answered

What is a Temporary Food Permit in Hawaii?

A Temporary Food Permit allows organizations, establishments, or individuals to distribute or sell food to the public for a limited time in Hawaii. This permit is essential for any food operation that lasts up to 20 dates within a 120-day period. It ensures that food safety and sanitation standards are met, protecting both vendors and consumers.

How do I apply for a Temporary Food Permit?

To apply for a Temporary Food Permit, you must complete the application form and submit it along with a non-refundable fee of $25. The application must be submitted at least ten working days before your event. Incomplete applications will not be processed. Ensure you provide details such as the name of your organization, the event location, and a list of food items you plan to sell. Additionally, you must include a site plan that shows your booth layout and handwashing facilities.

What are the requirements for the kitchen used in food preparation?

The kitchen used for food preparation must be an approved commercial kitchen, also known as a commissary. Home kitchens are not permitted. You need to provide the name, address, and permit number of this kitchen in your application. If you do not have direct access to an approved kitchen, you may submit a letter of authorization from the kitchen’s authorized person. This letter must include specific details about the kitchen and the person giving permission.

What happens if I do not comply with the permit regulations?

If you fail to comply with the sanitary requirements outlined by the Hawaii Department of Health, your Temporary Food Permit may be denied or revoked. It is crucial to adhere to food safety guidelines, such as keeping hot food above 140°F and cold food below 45°F. The Department of Health reserves the right to request additional information, such as a complete menu and schematic plan, to ensure compliance.

Common mistakes

  1. Incomplete Information: One of the most common mistakes is leaving sections blank. Each part of the form must be filled out completely. Omitting details can lead to delays or denial of your application.

  2. Incorrect Kitchen Information: Ensure that the name and address of the approved kitchen are accurate. Using a home kitchen or providing incorrect details can result in immediate rejection of your permit.

  3. Missing Signature: Forgetting to sign the application is a frequent oversight. Your signature is crucial as it confirms that you agree to comply with all regulations.

  4. Not Submitting on Time: Applications must be submitted at least ten working days prior to the event. Late submissions will not be processed, so plan ahead to avoid this mistake.

  5. Improper Payment: Ensure that the fee is paid correctly. The application will not be processed without the $25.00 fee. Double-check that your payment method is acceptable and that you include it with your application.

Documents used along the form

When applying for a Temporary Food Permit in Hawaii, several other forms and documents may be necessary to ensure compliance with local health regulations. Each document serves a specific purpose in the permitting process. Here’s a brief overview of some commonly required forms.

  • Site Plan: This document outlines the layout of your food booth, including the location of handwashing facilities and cooking equipment. It helps health inspectors visualize your setup and ensures you meet sanitation requirements.
  • Menu Submission: A detailed list of all food and beverage items you plan to serve at the event. This helps the health department evaluate the safety and preparation methods of your offerings.
  • Letter of Authorization: If you’re using an approved commercial kitchen, this letter from the kitchen’s owner grants you permission to operate from their facility. It should include relevant details about the kitchen and the authorized person.
  • Food Handler Certification: Proof that you or your staff have completed a food safety training program. This certification demonstrates your commitment to safe food handling practices.
  • Health Inspection Report: A recent inspection report from the approved kitchen, confirming that it meets all health and safety standards. This document is essential for ensuring that food is prepared in a safe environment.
  • Proof of Insurance: Some events may require liability insurance to protect against potential claims related to food safety or accidents. This document provides evidence of your coverage.
  • Application for Temporary Event Permit: If your food service is part of a larger event, you may need to submit an application to the event organizer for permission to participate. This often includes details about your booth and menu.
  • Vendor Agreement: A contract between you and the event organizers outlining the terms of your participation. This may include fees, responsibilities, and other important details related to the event.

Gathering these documents can streamline the application process and help you avoid delays. Always check with local health authorities for specific requirements related to your event, as regulations can vary. Proper preparation ensures a successful and compliant food service experience.

Similar forms

The Temporary Food Permit in Hawaii shares similarities with the Food Service Establishment Permit, which is required for permanent food service operations. Both documents necessitate detailed information about the food establishment, including the name, location, and contact details. However, the Food Service Establishment Permit applies to businesses that operate year-round, while the Temporary Food Permit is specifically designed for short-term events. Each permit also requires adherence to health and sanitation regulations, ensuring that food safety standards are maintained regardless of the duration of the operation.

Another comparable document is the Catering Permit. Like the Temporary Food Permit, the Catering Permit allows for the preparation and distribution of food outside of a traditional restaurant setting. Both permits require a list of food items to be served and details about the kitchen where food is prepared. However, the Catering Permit is typically used for events that are more private and may not be open to the public, while the Temporary Food Permit is aimed at public events such as fairs or festivals.

The Farmers Market Permit is also similar in purpose and structure. This permit allows vendors to sell food items directly to consumers at designated markets. Both permits require vendors to provide information about their food items and ensure that they comply with health regulations. However, the Farmers Market Permit is specifically for sales at farmers markets, while the Temporary Food Permit covers a broader range of events.

Additionally, the Mobile Food Vendor Permit shares characteristics with the Temporary Food Permit. Both documents require vendors to provide their location, contact information, and a list of food items. The Mobile Food Vendor Permit is intended for food trucks and carts that operate in various locations, while the Temporary Food Permit is for specific events. Both types of permits emphasize compliance with health and safety standards to protect public health.

The Special Event Permit is another document that resembles the Temporary Food Permit. This permit is often required for events that involve food distribution, including festivals and community gatherings. Both permits require detailed event information, such as dates and times, and both must be submitted well in advance of the event. The Special Event Permit may cover additional aspects of event planning, such as crowd control and sanitation facilities, whereas the Temporary Food Permit focuses primarily on food safety.

The Concessionaire Permit is also similar, as it allows vendors to operate food stalls at events. Like the Temporary Food Permit, this document requires a list of food items and ensures compliance with health regulations. However, the Concessionaire Permit is often associated with larger events, such as concerts or sporting events, where multiple vendors operate simultaneously. Both permits ensure that food served to the public meets safety standards.

Lastly, the Food Handler's Permit is relevant in this context, as it is often required for individuals working in food service. While the Temporary Food Permit is focused on the establishment itself, the Food Handler's Permit ensures that those preparing and serving food have the necessary training in food safety practices. Both permits work together to ensure that food is handled safely and responsibly, protecting public health at events.

Dos and Don'ts

When filling out the Temporary Food Permit Hawaii form, it is important to follow certain guidelines to ensure a smooth application process. Below is a list of things you should and should not do.

  • Do fill out the form completely and accurately. Incomplete forms may lead to delays or denial of your application.
  • Do submit your application and the $25.00 fee at least ten working days before your event.
  • Do provide a detailed list of all food items that will be sold or distributed at the event.
  • Do ensure that the kitchen you are using is an approved commercial kitchen, as home kitchens are not permitted.
  • Do include a site plan that shows the booth layout and handwashing facilities.
  • Don't forget to include the contact person's phone number and fax number. This information is essential for communication.
  • Don't submit the application without a signature from the authorized person of the kitchen. This step is crucial for approval.
  • Don't attempt to list more than one location or organization on a single permit application. Each permit applies to one location only.
  • Don't ignore the temperature requirements for food safety. Keep hot food above 140°F and cold food below 45°F.
  • Don't wait until the last minute to submit your application. Early submission will help avoid complications.

Misconceptions

Misconceptions about the Temporary Food Permit Hawaii form can lead to confusion and potential issues for applicants. Here are seven common misunderstandings:

  • All food can be prepared at home. Many believe that they can prepare food in their home kitchens. However, this is not permitted. Food must be prepared in an approved commercial kitchen.
  • The permit is valid indefinitely. Some applicants think that once they receive a permit, it lasts forever. In reality, the permit is only valid for a maximum of 20 dates within a 120-day period.
  • Applications can be submitted last minute. A common belief is that applicants can submit their forms just days before the event. The application must be submitted at least ten working days prior to the event.
  • Any kitchen can be used for food preparation. There is a misconception that any kitchen can be utilized. Only kitchens that have been specifically approved by the Department of Health may be used.
  • Food items do not need to be listed in detail. Some applicants think they can provide vague descriptions of food items. In fact, a complete list of food and drink items must be provided for approval.
  • The application is simple and can be completed quickly. While it may seem straightforward, incomplete applications will not be processed. Careful attention to detail is necessary.
  • Fees are refundable. There is a belief that the $25 application fee can be refunded if the permit is not granted. However, this fee is non-refundable regardless of the outcome.

Understanding these misconceptions can help ensure a smoother application process for those seeking a Temporary Food Permit in Hawaii.

Key takeaways

  • Filling out the Temporary Food Permit Hawaii form is essential for any organization or individual planning to sell food to the public. This applies to events lasting no more than 20 days within a 120-day period.

  • Ensure that all sections of the form are completed. An incomplete application will not be processed, which could delay your event.

  • Submit your application along with the $25.00 fee at least ten working days before the event. This timeframe allows the Department of Health to review and approve your permit.

  • Home kitchens cannot be used for food preparation. Only approved commercial kitchens, known as commissaries, are acceptable. Make sure to include the commissary's permit number on your application.

  • When listing food items, remember that no home-prepared food is allowed. It's crucial to keep hot food above 140°F and cold food below 45°F to ensure safety.

  • After approval, your permit can be picked up, faxed, or mailed to you. If you prefer the latter, include a self-addressed, stamped envelope with your application.