Form Ehsd0087C PDF Details

At Stony Brook University, the commitment to ensuring the health and safety of the campus community extends to all aspects of university life, including food services. The EHSD0087C form, a critical document designed to uphold food safety standards, plays a key role in this mission. This form is essentially a food permit application that organizations must complete and submit to the Environmental Health & Safety office at least 10 days before hosting any event where food will be served. The application process involves detailed planning around the type of event, the source of the food, how the food will be transported and maintained at safe temperatures, and who will be serving the food. The form asks for specifics about the food being served, ensuring that all items are prepared in a facility with the right permits and that any cooking on campus meets additional requirements. Importantly, it also mandates the recording of food temperatures at delivery and during the event to ensure safety. Approval from EH&S is essential; without it, food cannot be served at the event. This careful approach underscores the university's dedication to maintaining high standards of health and safety, underpinned by the comprehensive guidelines in EH&S Policy 1-15, Food Safety. The EHSD0087C form is more than just paperwork; it is a vital tool in promoting a safe dining experience at campus events.

QuestionAnswer
Form NameForm Ehsd0087C
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesEHSD0087C stony brook university food safety permit form

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STONY BROOK UNIVERSITY

Environmental Health & Safety

110 Suffolk Hall, Stony Brook, NY 11794-6200

Phone: 2-9683 Fax: 2-9683 Zip: 6200

www.stonybrook.edu/ehs

FOOD PERMIT

Instructions: Please read EH&S Policy 1-15, Food Safety, before completing this application. The policy is on EH&S’ website.

 

 

 

 

 

EVENT & CONTACT INFORMATION

Organization’s Name:

 

Filing Date to EH&S:

 

Food Coordinator:

 

Phone No.:

 

Campus Address:

 

FAX:

 

Name of Event:

 

Event Date:

 

Location of Event:

 

Time Food to be Delivered:

 

Approximate Number of Attendees:

 

Event Hours:

 

 

 

 

 

TYPE OF EVENT

□Campus Community Event

An event that is only open to the campus community (student, faculty and staff) and their invited guests only.

Instructions:

Food Coordinator’s must fully complete and submit this food permit application to EH&S at least 10 days prior to the event.

 

FOOD ESTABLISHMENT/SOURCE

Name:

 

 

 

 

Address:

 

 

 

 

Contact Name/Phone No:

 

 

 

 

Permit Number:

 

 

 

Expiration Date:

Does the Food Establishment

have ‘Off-Premises Catering’ on their permit? Yes

No

Distance of Food Establishment from University: within 10 miles

 

greater than 10 miles

 

 

 

 

 

 

 

 

 

 

FOOD SAFETY

List the foods you will be serving at the event. Be specific.

How will the food be transported and temperatures (Hot Food >140°F/Cold Food <41°F) maintained furing deliver?

Will any food praparation or cooking be performed on campus? □ Yes □ No Note: Food must be prapared in a permitted facility only. Additional permits and/or arrangements will be required, if cooking on campus.

Who will be serving the food (caterer, self serve, sponsoring group)?

How will safw food temperatures (Hot Food >140°F/Cold Food <41°F) maintained during the event? Type of equipment?

 

 

Identify equipment that you will provide and utlize to ensure safe handling:

 

 

 

□ Disposable gloves

□ Food thermometer

□Handwashin g location:___________

 

 

□ Aprons

□ Serving utensils

□ Other:________________________

 

 

 

Hair nets or hats

□ Disposable utensils

 

 

 

 

□

 

 

 

 

Signature of Food Coordinator:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EH&S APPROVAL AND AUTHORIZATION

 

 

 

 

□ APPROVED

 

□ DISAPPROVED

 

 

 

Your application for a food permit has been approed. The Food

FOOD MAY NOT BE SERVED AT THIS EVENT!

 

 

Coordinator is responsible for ensuring the safe handling of food

Your application for a good permit has been disapproved for

 

 

in accordance with this Food Permit and EH&S Policy 1-15. The

reasons noted below.

 

 

 

 

temmperature of food shall be taken and recorded on the Food

□ Lack of information

□ Transport

 

 

Temperature Recording Chart upon its arrival and at 30 minute

□ Food establishment

□ Handling

 

 

 

intercals. All food must be discarded after 2 hours.

□ Type of food

□ Other:___

 

 

 

 

 

 

 

EH&S Comments:

Reviewed by:

Phone:

Date:

EH&S Policy 1-15, Food Safety – Revised April, 2010

EHSD0087C (04/10) THIS PERMIT MUSTBE POSTED AT THE FOOD EVENT www.stonybrook.edu/ehs

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Pay close attention when filling out this document. Ensure that all mandatory fields are filled in properly.

1. It's essential to complete the Form Ehsd0087C accurately, therefore pay close attention when filling in the sections that contain all these fields:

Filling in part 1 of Form Ehsd0087C

2. Soon after performing the previous part, go to the subsequent part and enter the necessary particulars in all these blank fields - How will the food be transported, Will any food praparation or, How will safw food temperatures, Identify equipment that you will, Signature of Food Coordinator, APPROVED, EHS APPROVAL AND AUTHORIZATION, DISAPPROVED, Your application for a food permit, temmperature of food shall be, intercals All food must be, FOOD MAY NOT BE SERVED AT THIS, Your application for a good permit, reasons noted below, and Lack of information Transport.

Filling in part 2 in Form Ehsd0087C

3. This next part is about intercals All food must be, Lack of information Transport, EHS Comments, Reviewed by, Phone, Date, EHS Policy Food Safety Revised, EHSDC wwwstonybrookeduehs, and THIS PERMIT MUSTBE POSTED AT THE - fill out these blank fields.

Guidelines on how to fill out Form Ehsd0087C portion 3

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