Fillable Temporary Event Coordinator Application (Island Health)

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Temporary Event Coordinator Application (Island Health)

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The Temporary Event Coordinator Application (Island Health) form is 2 pages long and contains:

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  • 94 check-boxes
  • 57 other fields

Country of origin: CANADA
File type: PDF

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SPECIAL EVENT COORDINATOR APPLICATION
To be completed for events with 10 or more food or personal service vendors
• Coordinators must submit this application to the local Health Protection Office at least 14 DAYS PRIOR TO THE
EVENT. 28 days is strongly recommended to ensure adequate processing time.
• If approved, a copy of this application will be returned to be retained onsite for reference.
OTHER SUBMISSIONS to be included with this application:
1. Application to Operate a Temporary Food Premises (for Special Event Food Service) for each temporary food vendor.
2.
Site
plan (with vendor locations, food storage areas, water supply, wastewater, garbage disposal, activities, etc.)
EVENT INFORMATION
NAME OF EVENT
EVENT LOCATION (E.G., NAME OF PARK)
ADDRESS (STREET / CITY)
☐INDOORS
☐OUTDOORS
EVENT DATE(S)
HOUR(S) EVENT WILL BE OPERATING
OPENING TIME
ESTIMATED DAILY ATTENDANCE
PETTING FARM ONSITE?
☐
NO
☐
YES
If Yes, Describe:
TATTOO/ PIERCER/BODY MODIFICATION ONSITE?
☐
NO
☐
YES
If Yes, Describe:
BATHING BEACH, POOL/HOT TUB/ SLIP & SLIDE) ONSITE? ☐NO ☐YES
If Yes, Describe:
COORDINATOR INFORMATION
NAME OF COORDINATOR
TELEPHONE NUMBER
CELL PHONE NUMBER
MAILING ADDRESS
STREET
FAX NUMBER
E-MAIL ADDRESS
CITY PROVINCE POSTAL CODE
NAME OF PERSON IN CHARGE ON DAY OF EVENT
TELEPHONE NUMBER
CELL PHONE NUMBER
APPLICANT SIGNATURE
The information enclosed is true and accurate to the best of my knowledge. I understand that requirements must be met
in accordance with Section 6 of the B.C. Food Premises Regulation or the event will not receive approval to operate.
Date: _______________________________ Signature:______________________ ________________
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signature
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NAME OF EVENT
EVENT DATE(S)
Mobile
Unit
Caterer
Booth
Other
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
EVENT AND VENUE DETAILS- The Coordinator will provide the following:
□
Power Supply
□ Hot water
□
Food storage/Refrigeration
□
Sanitizer Solution
□ Liquid collection/disposal
□ Washrooms (toilet and sink)
□
Booth construction
□ Garbage collection/disposal
□
Potable water supply (describe source):
□
Handwashing station (number, location):
□
Water distribution (describe, list hose type):
□
Other (describe/explain):
EHO Approval:
Date:
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Temporary Event Coordinator Application (Island Health)

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Completed 15 July 2020

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