Fillable Austin ISD Facility Use Office BUILDING USE APPLICATION (Austin Independent School District)

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Austin ISD Facility Use Office BUILDING USE APPLICATION (Austin Independent School District)

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Updated 5/14/14 1 of 2
Austin ISD Facility Use Office
Baker Center, Rm. 205 ● 3908 Ave B ● Austin, TX 78751
512-414-0331 ● 512-414-0355 ● 512-414-0372 ● 512-414-0451 (ph) / (512) 414-1228 (fax)
BUILDING USE APPLICATION FOR NON-SCHOOL GROUPS
DIRECTIONS: Please complete ALL details of this application. It must be signed by an officer of the
organization requesting building use and submitted to the school principal or designee for approval and
signature THREE WEEKS prior to the requested date. If you will be serving any type of food, you MUST
obtain a Temporary Food Event Permit from the Austin/Travis County Health and Human Services
Department (application attached). Submit completed application to the Facility Use Office after it has
been approved by the campus.
Type or Print ALL Information Requested Application Date:
Organization
For Profit
Nonprofit, not school-affiliated
YSM Registrant
Contact person
Campus
Address
Event [For-Profit Organizations must attach a brief explanation of how this event will
contribute to the betterment of the school or
g
anization
)
City/state/zip
Event date(s)
Event times
Participant Fee $
# Participants____ Children______ Adults______
Event date(s)
Event times
Facilities Requested (specify if necessary) Hourly Rate # Hours Use Fee
Gym
Cafeteria
Kitchen

Auditorium
Library
Classrooms How many?_____
Other areas (please list)
Use Fee Total $
Additional Services or Equipment Hourly Rate # Hours
Fringe Benefits
(Hourly Rate x Hrs x 1.2048)
Total Cost
Custodian
Building monitor
Security
Supplies
Other services or equipment (please list)
Other Costs Subtotal $
Explanation of Fees
TOTAL FEES
$
This fee must be paid in advance unless
otherwise approved in writing.
* School-support organizations are non-profit organizations formed for the purpose of providing support and/or raising funds
for the betterment of the AISD school(s).

An AISD Food Services employee MUST be present if AISD kitchens are used. If any food not prepared in an AISD kitchen
will be served, a Temporary Food Event Permit must be obtained from the Austin/Travis County Health and Human Services
Department (application attached).
Updated 5/14/14 2 of 2
CONDITIONS OF APPLICATION: In making this application, it is understood and agreed that the Rules and Regulations
Governing the Use and Rental of School Facilities as adopted by the Board of Trustees of the Austin Independent School
District be adhered to in every instance. A complete copy of these Rules and Regulations is available in the Office of
Community Education, or online under Board Policy GKD. Pertinent excerpts read as follows:
The applicant must not make firm plans, advertise activities, or sell tickets to an event prior to receiving written approval from the Facility
Use Office for the use of school facilities.
Indemnification: Austin ISD shall not be responsible for any accidents arising out of the contractor’s operations. Contractor shall be fully
responsible for the safety of its operations and its employees, clients, visitors and others associated with its activities. To the fullest extent allowed
by law, contractor agrees to defend, indemnify and hold AISD, its directors and employees harmless from any and all claims, judgments causes of
action, costs, and expenses resulting from injury to or death of any person or damage to any property, to the extent caused by the negligent
actions or omissions or willful misconduct of contractor’s agents, servants, employees, subcontractors or suppliers in connection with the
program.
Damage to or misuse of the facilities and equipment of the District will be paid for in full by the organization that submitted
the application for use of the facility. Applicant must provide proof of insurance in accordance with Contractor Insurance
Guidelines.
All written material over which the school does not exercise control and that is intended for distribution on school property or that
involves the use of school facilities shall be submitted for prior review according to the procedures outlined in Board Policy GKD
(Local). Such materials must state clearly that the event(s) is in no way sponsored or supported by either AISD or the facility at
which the event(s) is held.
CANCELLATION OF USE: The following provisions will govern cancellation:
1. Facility use approvals may be cancelled at any time there is evidence that Board policies are being violated. In case
of cancellation, the Board assumes no liability other than return of fees charged for unused facilities.
2. Principals will give at least one week’s notice if a previously approved facility use agreement must be cancelled or
postponed due to an unexpected conflict with a school-sponsored activity.
AISD will make facilities accessible in compliance with the Americans with Disabilities Act.
Other Conditions (attach additional pages if necessary): Organizations requesting use of fields will not be entitled to a refund or
credit due to weather or cancellations. __________________________________________________________________________
Criminal History Record Information Requirement: Company shall, at its sole cost and expense, obtain for each covered employee the criminal
history record information as required by TEC §22.0834. The term “covered employee” shall mean any individual employed by Company. Company
shall not allow on District Property any covered employee who has been convicted of (i) a felony offense under Title 5 of the Texas Penal Code; (ii) an
offense on conviction of which a defendant is required to register as a sex offender under Chapter 62 of the Texas Code of Criminal Procedure; or (iii)
an offense under the laws of another state or federal law that is equivalent to an offense under (i) or (ii) above, if at the time the offense occurred, the
victim of the offense was under 18 years of age or enrolled in a public school. If during the period Company is providing services under this
Agreement, Company or the District receives updated criminal history record information for a covered employee that includes a disqualifying criminal
history under this paragraph 6, Company shall prohibit such covered employee from future entry on District Property. The terms “continuing duties”
and “direct contact with students” shall have the meanings designated for such terms in 19 TAC §153.1101. The District will be the final arbiter of
what constitutes continuing duties and direct contact with students.
A
PPLICANT:
A
ISD:
T
ype or print name of authorized representative Department of School Family & Community Education
Signature of authorized representative Date
A
uthorized representative home/business address Food Services
Email address Date
Office phone Home phone
Signature of authorized representative Date
A
pplication Approved: [ ]
A
pplication Denied: [ ]
Reason for Denial: [ ] Conflict with school event(s) [ ] Activity is inappropriate for a school facilit
[ ] Other reason (explain)
School Principal Date
Campus Contact Phone number
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AISD & ATCHHSD Revised 9/14/17 NO HOME-PREPARED FOODS ALLOWED
1
FOR HEALTH OFFICE USE
Date Received: _________________ Received By:___________ Permit # _____________________________AISD EXEMPT
Austin Public Health
Environmental Health Services Division
P.O. Box 142529, Austin, TX 78714
Phone (512) 978-0300 Email: EHSD.Service@austintexas.gov
http://www.austintexas.gov/department/business-applications-and-guides
Permit Pick-up Location (not mailing address): 1520 Rutherford Lane, southeast entrance of Building 1, 2
nd
floor (NE corner of Rutherford @ Cameron)
Please complete our Environmental Health Services survey at www.surveymonkey.com/s/EHSDSurvey
AISD-SPONSORED TEMPORARY FOOD EVENT PERMIT APPLICATION
AISD EVENT INFORMATION
Name of Event:_________________________________________________________________________________________
Campus: ______________________________________________________________________________________________
School Name Address City State Zip
Dates(s) of Event (must be consecutive days): ______________________________ ______________________________
Start Date End Date
Hours of Operation (for each day): _________________________________________________________________________
*The food booth(s) shall be set-up and ready for an inspection at the hours listed under Hours of Operation for each day.
Total # Food Booths (vendors): ______ Event Fee Exempt? YES – (AISD Sponsored event fee exemption)
CONTACT (EVENT ORGANIZER) INFORMATION
Name of Organization: ______________________________________________ School-group Nonprofit-school support
Name of Contact Person (Authorized Representative of Organization):___________________________________________
First Name Last Name
Contact Person’s Mailing Address: ________________________________________________________________________
Address City State Zip
Phone Number: (_______)______________________ E-mail Address: ___________________________________________
Driver's License Number & State: ______________________________ Date of Birth: ______________________________
***ATTACH A CLEAR COPY OF A VALID GOVERNMENT ISSUED PHOTO ID FOR THE EVENT ORGANIZER***
APPLICATION SUBMISSION
Submit pages 1, 2, 3 & 4 (multiple submissions of pages 3 and 4 may be required) of this application with a clear copy
of a valid government issued photo ID to AISD Office of Food Services 3 weeks prior to the event.
Austin Independent School District: Office of Food Services
Baker Center, 3908 Avenue B, Room 212, Austin, TX 78751
Phone (512) 414-0251 Fax (512) 414-0381 www.austinisd.org
AISD & ATCHHSD Revised 9/14/17 NO HOME-PREPARED FOODS ALLOWED
2
PERMIT COMPLETION & PICK-UP
1.) After AISD approves the sponsorship, they will submit the completed application to this Health Department, who will notify the
applicant when the permit has been processed and is ready to be picked-up at Health’s walk-in location.
2.) Walk-in Location: 1520 Rutherford Lane, southeast entrance of Building 1.
3.) Permits must be picked up at Health’s office (no mailing or faxing of permits).
4.) Permits must be posted onsite at all operating times during the event to avoid legal charges (Lost/missing permits are invalid).
This form must be filled out completely. INCOMPLETE FORMS WILL NOT RECEIVE PERMITS. Submission of this form does
not guarantee that a permit will be granted. Permit approval is based upon compliance with State and Local Health
requirements. IT IS THE RESPONSIBILITY OF THE EVENT ORGANIZER (NOT THE INDIVIDUAL VENDOR) TO OBTAIN
TEMPORARY FOOD PERMITS FOR EACH VENDOR AT THE EVENT. Please see the Temporary Food Event Permitting
FAQs (page 10) for information relating to permit and food handling requirements. Note: The Temporary Food Event Permit
approval process is separate from the Building Use approval process. GRANT OF A TEMPORARY FOOD EVENT PERMIT
DOES NOT MEAN THAT THE APPLICANT’S APPLICATION FOR USE OF THE SCHOOL FACILITY HAS BEEN APPROVED.
By signing this form, I attest that all information contained herein is true and correct to the best of my knowledge and belief. I
acknowledge that any permit applied for is subject to all provisions of the orders and ordinances of Travis County or Austin or
the municipality under which the permit is granted, all provisions of the statutes and rules adopted under the statutes of the
State of Texas governing food service establishments, retail food stores, mobile food units and roadside food vendors, and to
all provisions of the policies adopted by the Austin Independent School District.
___________________________________________________ _______________________________
SIGNATURE OF EVENT ORGANIZER (APPLICANT) DATE
By signing this application, the applicant acknowledges that the permit being applied for is subject to Local/State Codes under
which it is granted. Completing this application does not guarantee that a permit will be issued by this Department.
Incomplete applications will delay or prevent permitting.
No food establishment/event may operate without an approved permit issued by this Department.
“Rain-out” delays may be granted if notification is received within 24 hours after cancellation.
An individual may only apply for four (4) temporary events per year.
Permits are address-specific and non-transferable and must be picked up at Health’s office (no mailing or faxing of permits).
The event organizer (not the individual booth operator) is responsible for obtaining Temporary Food Permits for each booth at the event.
DEFINITIONS
Temporary Food Service Establishment is defined as service of food at a location for no more than 14 consecutive days in
conjunction with an organized event or celebration.
Booth (serving area) is defined as a stall or partitioned stand used to present, prepare, or provide food to the general public.
Potentially Hazardous Food (PHF) requires temperature control to limit foodborne pathogens & toxin production.
Some PHF examples are meats, dairy, cooked vegetables, sliced melons, cooked beans, cooked rice and cooked pastas.
REMEMBER: DANGER ZONE FOR PHF IS BETWEEN 41°F AND 135°F.
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AISD & ATCHHSD Revised 9/14/17 NO HOME-PREPARED FOODS ALLOWED
3
RESPONSIBLE PARTIES (WITH FOOD TRAINING VERIFICATION)
At least 2 individuals must be present at the event at all times and must be the contact people for the City if the City determines
that a health code violation is occurring at the event. Please list the names of at least 2 individuals who attended the required
training, as well as the date of their training. At least 1 of the individuals must be the Organization’s Authorized Responsible
Party submitting this application. If an individual needs to obtain certification and cannot attend one of the training opportunities
offered each semester, training can be accessed online at www.statefoodsafety.com/food-handler/texas/austin-city.
1. Name of Responsible Party: Date of Training: □
Contact phone number during event: __________________________________________
2. Name of Responsible Party: Date of Training: □
Contact phone number during event: __________________________________________
FOOD AND BEVERAGE BOOTH INFORMATION
Please PRINT and use additional sheets if necessary
Example: Name of booth: Austin A+ Booster Club
Type of foods/beverages to be served: chili pie, popcorn, cut vegetables, drinks
1. Name of booth:
Type of foods/beverages to be served:
2. Name of booth:
Type of foods/beverages to be served:
3. Name of booth:
Type of foods/beverages to be served:
4. Name of booth:
Type of foods/beverages to be served:
5. Name of booth:
Type of foods/beverages to be served:
6. Name of booth:
Type of foods/beverages to be served:
7. Name of booth:
Type of foods/beverages to be served:
8. Name of booth:
Type of foods/beverages to be served:
9. Name of booth:
Type of foods/beverages to be served:
10. Name of booth:
Type of foods/beverages to be served:
AISD & ATCHHSD Revised 9/14/17 NO HOME-PREPARED FOODS ALLOWED
4
TEMPORARY FOOD EVENT RESPONSIBLE PARTY IDENTIFICATION
NO HOME-PREPARED FOODS ALLOWED
This page is required to be signed and submitted by each booth operator that is a separate entity from
the other booth operators. Please PRINT and use additional sheets if necessary.
I, ___________________________, am the operator of the temporary food service booth named:
Print Your Name
_________________________________________ providing food at the following temporary event named:
Booth’s Name from Page 3
______________________________________ on this date, __________________________________.
Temporary Event Name from Page 1 Date(s) this booth is at the Event
Type of food/beverages to be served: ____________________________________________________________
__________________________________________________________________________________________
The food will be obtained from the following approved sources (check all that apply):
I operate from/own a permitted food facility (such as a restaurant).
Food Facility Name: ___________________________________________________________________
Facility Address: __________________________________________________________________________
Address City State Zip
I will purchase or receive donated food from a permitted food facility (such as a grocery store or
restaurant) on the day of the event and bring the food directly to the event. I will maintain my food
receipts or letter of donation onsite at the event in case the inspector needs to verify food source.
Food Facility Name: ___________________________________________________________________
Facility Address: __________________________________________________________________________
Address City State Zip
Phone Number: (__________)___________________________
I hereby certify that I have received the guidelines for temporary food service requirements provided by the Austin/Travis
County Health and Human Services Department, AISD, and the Event Coordinator.
I understand that, as a condition of my operation at this event, I am responsible to insure that these guidelines are strictly
adhered to at all times. I will conform to these guidelines and insure that all individuals involved in this operation conform to
these guidelines. Failure to do so may result in the immediate suspension of my operation at this event and may result in a
complaint being filed against me in the Municipal Court of the City of Austin for a violation of these guidelines and the Code of
the City of Austin. I understand that such a complaint might result in a fine of up to $2,000 on conviction.
Signature: ___________________________________ Printed Name: ________________________________
Today’s Date: ________________________________ Phone Number: _______________________________
Mailing Address: ___________________________________________________________________________
Address City State Zip
Driver’s License Number & State: _________________________ Date of Birth: _______________________
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AISD & ATCHHSD Revised 9/14/17 NO HOME-PREPARED FOODS ALLOWED
5
CRITICAL REQUIREMENTS
These are the requirements for temporary food service in Austin and Travis County based on the
Texas Food Establishment Rules and have been adopted by the City of Austin and Travis County.
These are the requirements for Austin Independent School District Temporary Food Service Public Events.
**Violation of a critical requirement shall result in an immediate closure, condemnation of
food products and/or legal charges. All Health Closures are in instantaneous effect until the
critical items are corrected and verified by an authorized representative of this Department.
If serving an Highly Susceptible Population (children 0 - 9 years old), then ABSOLUTELY NO RAW OR PARTIALLY-COOKED
MEATS (including EGGS), NO UNPASTEURIZED JUICES, AND NO RAW MILK OR RAW MILK PRODUCTS
1. Keep potentially hazardous foods colder than 41°F or hotter than 135°F at all times. Heat hot food to 165°F and
maintain at >135°F. Any portion of a potentially hazardous food held between 41°F and 135°F is in the DANGER ZONE.
2. Provide IMMEDIATE access to hand washing for food handlers, including: hand soap, paper towels, container of water
with a “free-flowing” spigot and a wastewater catch bucket. ONLY after washing hands may gloves, tongs, or a hand-sanitizer
be used to handle ready to eat foods. A catch bucket must collect the wastewater for proper disposal.
3. Provide WASH, RINSE, SANITIZE setup for ware-washing. The first basin is for washing and has soap and water only.
The middle basin is for rinsing and has only clean water. The third basin is for soaking utensils in a sanitizing solution of 50-
100ppm chlorine as tested by chlorine test strips. Remember the proper sequence: WASH, RINSE & SANITIZE!
4. Use “active” temperature control equipment. Holding hot food in an insulated container with NO active source of heat is
NOT allowed. Sterno is not permitted for outdoor events, unless properly hooded to prevent wind effects. Active refrigeration
will be required for multiple day events. Drained ice may be used for short term holding of cold food.
5. Monitor food temperatures with a chef-style metal stem-type thermometer. Thermometers should have a range of 0°F-
220°F. Thermometers should be cleaned and sanitized between uses.
6. Use only cutting boards, utensils, equipment, food preparation and serving surfaces that are smooth, durable, easily
cleanable, and non-absorbent. Wash food contact surfaces every 4 hours (or immediately when contaminated).
7. Separate raw and ready to eat foods. Don't cross-contaminate. Use different sets of utensils and prep surfaces.
8. Test sanitizer with chlorine test paper. Bleach = 50-100 ppm. Test papers can be found at restaurant supply stores.
9. Use spray bottles of sanitizing solution and paper towels to frequently wipe counters and to spot clean equipment.
10. Store EDIBLE ice for drinks or consumption in the original bag inside an ice chest during service. Ice bags shall be
punctured underneath to allow drainage and open on the top to allow dispensing using a scoop with handles. Consumers
shall not dispense their own ice for drinks. Ice used to keep food cold cannot be used for consumption or drinks.
11. Protect all foods, utensils and paper goods from exposure to dirt, animals, and insects. Best practice is to cover or
wrap all items. Store foods 6 inches or more above the ground. Avoid handling the inside of cups, lids, or food containers.
12. Provide only disposable or single-use utensils, plates, cups, knives, forks, spoons, etc. to consumers. Unless using
an on-site commercial-grade dishwasher with running hot & cold water, sanitization cycle & that drains into a sanitary sewer.
13. Provide only condiments that are individually packaged or dispensed from an approved covered container. Spoon-
in-jar setups are not allowed due to the likelihood of cross contamination between plates.
AISD & ATCHHSD Revised 9/14/17 NO HOME-PREPARED FOODS ALLOWED
6
14. Collect drainage water from ice bins, ice chests, beverage dispensers, hand & utensil washing for disposal. Ensure all
wastewater enters a sanitary sewer. Drainage on the ground may become a source of pollution & contamination.
15. Provide covered garbage containers with plastic liners. Covers help to prevent insect transmission of pathogens.
16. Provide floor covering that will eliminate dust and be easily cleaned. Flooring must be in cooking, serving, food
preparation, and washing areas. Approved examples include concrete, asphalt, plywood, linoleum, clean cardboard, etc.
17. Provide overhead covering above food preparation, serving, and washing areas to protect from hazards (like birds).
Frequently Asked Questions (FAQ):
What is a temporary food event? Any public gathering where food is offered for consumption for no more than 14
days. An example of a public gathering means that it has any one of these scenarios: 1) walkup participation, 2) any
advertisement (including social media) OR 3) tickets are sold.
Do I need to get a permit? It depends: Yes a permit must be obtained if you meet the definition of a temporary event
above and offer either open or potentially hazardous foods. No permit is needed if using: 1) only the school cafeteria &
staff, or 2) a Mobile Vendor (with a valid Austin/Travis County Health and Human Services Department permit) that
serves all food directly from their vehicle or 3) only serving sealed commercially-prepackaged non-potentially hazardous
foods (like wrapped candy, sealed microwave popcorn, individual bags of chips, or bottled drinks).
How do I get a permit? Complete this AISD-sponsored Temporary Food Event Permit Application and follow the
instructions. Contact your campus Food Services Manager to plan food and sanitation as far in advance as possible.
What needs to be planned beforehand with the AISD Food Services Manager? Plans for Event must include a
method for compliance with food safety laws including 1) access to toilet facilities for everyone, 2) a separate (non-
restroom) water supply for handwashing station refills, 3) trash services, wastewater & grease disposal facilities and
method to collect dirty water from booths to the sanitary sewer, 4) electrical supply to booths for temperature equipment,
5) identification of potentially hazardous foods served at event to be listed on page 3 under corresponding booth name.
What is a Booth (Vendor)? Also thought of as a temporary kitchen or serving area. Traditionally, a 10'x10' tent with
floor covering or other ground dust control. Almost every booth will require a temporary hand wash setup.
Who is the Event Organizer and what's their job? The individual in charge of the whole event, typically a voluntary
contact person for a school-related organization. Responsible for 1) making sure that all the food vendors at the event
are invited and permitted, 2) this application submission, 3) distributing this information to all vendors and collecting the
completed “Responsibility page” (page 4) from each separate booth vendor, which must be included with the completed
application and 4) for providing & ensuring posting of the permit at each required booth at the event.
Who is the Food Booth Operator? The individual in charge of the food, typically restaurant staff or voluntary food
servers with a school-related organization. Responsible for 1) following the Texas Food Establishment Rules, 2) the
booth setup, 3) providing a safe and consumable product that has been properly handled.
How do I know if it is a Permitted Facility (page 4)? Contact the facility or ATCHHSD to verify current status. Many
recently permitted facilities are listed at: http://www.austintexas.gov/department/restaurant-inspection-scores
HINTS:
Serve only foods requiring minimum preparation such as seasoning or cooking. All cutting, slicing, or
chopping should be done in a permitted facility beforehand (note: NEVER AT HOME!)
AISD & ATCHHSD Revised 9/14/17 NO HOME-PREPARED FOODS ALLOWED
7
Pre-portion food into small leak-proof containers. Then immerse these containers/bags in ice to keep food
cold for short term. If the food bag leaks, then the food may become contaminated by the ice water. If the food
is too well protected, then it may not get cold enough to avoid the DANGER ZONE.
Sanitizer for Warewashing: suggested recipe = 1 1/2 teaspoons bleach per gallon of clean water
Don't skip the soap. Hand sanitizer alone doesn't stop Norovirus.
Dispose of everything properly. Don't contaminate our groundwater or “feed the wildlife”!
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Austin ISD Facility Use Office BUILDING USE APPLICATION (Austin Independent School District)

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Completed 13 March 2021

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