Environmental Health Division
1675 W. Garden of the Gods Rd., Suite 2044
Colorado Springs, CO 80907
(719) 578-3199 phone
(719) 578-3188 fax
www.elpasocountyhealth.org
Temporary Event
Retail Food Establishment Review Form
GENERAL REQUIREMENTS
Food vendors in El Paso County must hold a valid Colorado Retail Food Establishment (RFE)
T e m p o r a r y E v e n t License from any county in the State of Colorado, except the City
and County of Denver. Vendors with valid Colorado Retail Food Establishment Licenses
issued for temporary Event food service by another county health department, or the
Colorado Department of Public Health and Environment, are not required to obtain a
license through El Paso County Public Health and are not required to complete this
review form.
To obtain a RFE License through El Paso County Public Health, this review form must be
completed by the applicant and approved by the Environmental Health Division. There is no
submission fee, but RFE License fees are applied according to the Food Protection Act; Section
25-4-1607, Colorado Revised Statutes.
RFE Licenses are valid for the calendar year and expire on December 31 st of each year. RFE
Licenses may be renewed on or before December 31st of each year. If a License is not renewed,
a new RFE License Application and a new review form will be required to obtain a new license.
If the proposed menu for a Temporary Event RFE requires “complex” pre-preparation of food,
such as cooking, dicing and chopping of meats or vegetables, or if food utensils and/or other
food contact items must be cleaned, such work must be performed within an approved
commercial facility or “commissary”, which is subject to inspection and must be in
compliance with 6 CCR 1010-2, Colorado Retail Food Establishment Rules and
Regulations. If a commissary is required, a complete “Temporary Event Commissary
Certificate” form (below) must be submitted. No alternative documents will be accepted.
Submit this review form no less than ten (10) business days prior to the first Temporary Event.
The Retail Food Establishment License fee must be paid in full before the review form
will be processed. If the proposed Temporary Event food service is approved, El Paso
County Public Health will issue a Colorado Retail Food Establishment Temporary Event License
for the current year.
Rev 07/15
Temporary Event – RFE Review Form
Page | 2
VENDOR INFORMATION
Name of Establishment:
Applicant Name:
Mailing Address:
Colorado Department of Revenue Sales Tax Account #:
Contact Person:
Business Phone #:
On Site Cell #:
Email Address:
MENU
Hot Food Items
1.
Will any hot foods be prepared and/or cooled at an off-site location prior to Temporary Events?
( )NO – Complete Hot Food Items Table, below, for any hot foods that will be served. Then, skip to
Cold Food Items section.
( )YES – A Temporary Event commissary is required. Complete Hot Food Items Table,
below, and Temporary Event Commissary Certification on last page.
HOT FOOD ITEMS
Food Item
Source of Item
(name of grocer, wholesaler, etc.)
Off-Site
Preparation
Required?
(Yes or No)
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Temporary Event – RFE Review Form
Page | 3
2. How will hot food items be cooled to 41°F or below?
3. During Temporary Events, how will hot foods that have been cooled, be reheated to at least 165⁰F?
4. During Temporary Events, how will hot foods be cooked?
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Temporary Event – RFE Review Form
Page | 4
5. During Temporary Events, how will hot foods be held at 135⁰F or higher?
6. What utensils will be used to prepare or serve hot food items?
7. How will left-over cold food items be handled?
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Temporary Event – RFE Review Form
Page | 5
Cold Food Items
1. Will any cold foods be prepared at an off-site location prior to Temporary Events?
( )NO – Complete Cold Food Items Table, below.
( )YES – A Temporary Event commissary is required. Complete Cold Food Items Table,
below, and Temporary Event Commissary Certification on last page.
COLD FOOD ITEMS
Food Item
Source of Item
(name of grocer, wholesaler, etc.)
Off-Site
Preparation
Required?
(Yes or No)
2. How will cold foods be held at 41⁰F or below during Temporary Events?
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Temporary Event – RFE Review Form
Page | 6
2. What utensils will be used to prepare or serve cold food items?
3. How will left-over cold food items be handled?
FIELD EQUIPMENT AND SUPPLIES
1. Describe equipment that will be used to prepare food during Temporary Events, and how it will be used.
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Temporary Event – RFE Review Form
Page | 7
2. Describe equipment that will be used to transport food or to store/hold food during Temporary Events.
3. Describe equipment and supplies that will be used to set-up a hand washing station during
Temporary Events, and how it will be used.
4. Describe equipment and supplies that will be used to sanitize surfaces during Temporary Events.
5. Describe equipment that will be used to collect wastewater, trash and garbage during Temporary
Events.
6. Where will wastewater, trash and garbage be disposed?
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Temporary Event – RFE Review Form
Page | 8
FLOOR PLAN
Provide a simple drawing of the proposed establishment setup.
•
•
•
Identify cooking, storage and food prep areas.
Show the location of the hand washing station and the customer service area.
Also indicate the area with over-head coverage and note any side-walls or other barriers.
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Temporary Event – RFE Review Form
Page | 9
APPLICANT STATEMENT
I affirm that, to the best of my knowledge, that the above information is correct. I further agree to operate
the above mentioned Temporary Event Retail Food Establishment in compliance with 6 CCR
1010-2, Colorado Retail Food Establishment Rules and Regulations.
APPLICANT
DATE
ENVIRONMENTAL HEALTH COMMENTS
Approved By:
Date:
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Temporary Event – RFE Review Form
Page | 10
Temporary Event Commissary Certificate
PART 1
(to be completed by Temporary Event food vendor)
Mobile Unit / Food Booth Name:
Owner’s Name:
I hereby affirm that I will use the Retail Food Establishment noted below as my Temporary
Event commissary for the preparation and storage of food items, cleaning of equipment and
utensils and other uses as required by 6 CCR 1010-2, Colorado Retail Food Establishment
Rules and Regulations.
Signature:
Date:
Print Name:
PART 2
(to be completed by commissary owner)
Name of Facility:
Location Address:
City, Zip:
Phone:
STATEMENT / AFFIDAVIT of COMMISSARY OWNER
I affirm that I am the owner/manager of the above referenced non-residential facility and agree
to allow the above referenced Temporary Event food vendor use of the facility for the
storage and preparation of food, for the washing and sanitizing of equipment, and for the
daily servicing of equipment. I further authorize El Paso County Public Health to conduct any
necessary inspections of the commissary. This agreement is valid through December 31st of
the current calendar year, but may be revoked at any time by providing written notice to El
Paso County Public Health.
Signature:
Date:
Print Name:_
Rev 07/15
CR 0002 (06/09)
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
DENVER CO 80246-1530
Departmental Use Only
RETAIL FOOD ESTABLISHMENT LICENSE APPLICATION
FOR CALENDAR YEAR 2015
This application will be rejected unless all questions are fully answered, proper remittance is
attached, and Health Department approval is obtained. The state may convert your check to
a one time electronic banking transaction. Your bank account may be debited as early as the
same day received by the State. If converted, your check will not be returned. If your check is
rejected due to insufficient or uncollectible funds, the Department of Revenue may collect the
payment amount directly from your bank account electronically.
Mail remittance and application to:
Health Department Approval
El Paso County Public Health, C/O Environmental Health Division
1675 W. Garden of the Gods Rd., Suite 2044
Colorado Springs, CO 80907
Type of Ownership
Individual (If individual or sole proprietor owner, you must complete the enclosed affidavit and provide a notarized copy of an approved identification.)
General Partnership
Limited Partnership
Limited Liability Company
Limited Liability Partnership
Limited Liability Limited Partnership
Corporation
“S” Corporation
Association
Estate
Government
Joint Venture
Trust
Non-Profit 501(c)(3) [ Please enclose copy of IRS letter of exemption]
Other Non-profit
Certificate/License to be issued in the name(s) of (full legal name of corporation; individual owner or name of first partner)
(names of second and additional partners or corporation officers)
Trade Name (DBA)
FEIN Number/Social Security Number
Business Located at (street or rural route, city, state, and ZIP code)
County in which business is actually located
Phone Number
Mailing Address (if different from location above; include street, city, state, and ZIP code)
Date you started the business
If seasonal, mark each
business month
JAN
MAR
MAY
JULY
SEPT
NOV
FEB
APR
JUNE
AUG
OCT
DEC
Seasonal Date of Operation: Begin Date _____ / ____ End Date _____ / _____
Month
Day
Month
Day
Are you liable for reporting state sales tax?
Yes
No
Liquor?
Yes
No
Gaming?
Yes
No
Name and address of previous owner
Colorado Sales Tax Account Number (required)
In consideration thereof, I do hereby certify that I have complied with all items of sanitation as listed in the Colorado Retail Food Establishment Code, and that I
have complied with all orders given me by authorized inspectors of the Colorado Department of Public Health and Environment or local board of health. I do hereby
agree that in the event that the items of sanitation are not complied with, I will discontinue serving food until such time as requirements are met.
Signature
Title
Date
Name and address of current owner
Colorado Sales Tax Account Number (required)
Calendar Year
For Health Department Use Only
No fee License (School, Charitable, Other) .. (3273
Mobile Unit .................................................... (3289
Mobile Unit (Prepackaged Food)
(3292
Temporary/Special Event Establishment ...... (3291
Temporary/Special Event(Prepackaged Food) (3293
Restaurant 0-100 Seats .............................. (3274
Restaurant 101-200 Seats .......................... (3275
Restaurant Over 200 Seats ........................ (3276
Grocery Store 0-3,500 Sq Ft ....................... (3277
Grocery Store 3,501- 15,000 Sq Ft ............. (3278
Grocery Store 15,001-25,000 Sq Ft ............ (3279
Grocery Store 25,001-45,000 Sq Ft ............ (3280
Grocery Store 45,001-65,000 Sq Ft ............ (3281
Grocery Store 65,001-85,000 Sq Ft ............ (3282
750) ...... $0
750)…..$255.00
750)….$115.00
750)….$255.00
750)….$115.00
750)….$255.00
750)….$285.00
750) .... $310.00
750)….$115.00
750) ….$180.00
750)….$200.00
750)….$235.00
750)….$290.00
750)….$415.00
Grocery Store Over 85,000 Sq Ft ............. (3294
Grocery w/Deli 0-3,500 Sq Ft .................... (3283
Grocery w/Deli 3,501-15,000 Sq Ft ........... (3284
Grocery w/Deli 15,001-25,000 Sq Ft ......... (3285
Grocery w/Deli 25,001-45,000 Sq Ft ......... (3286
Grocery w/Deli 45,001- 65,000 Sq Ft ........ (3287
Grocery w/Deli 65,001- 85,000 Sq Ft ........ (3288
Grocery w/Deli Over 85,000 Sq Ft ............ (3295
Oil & Gas Temp. 0-50 (Initial License) ..... (3296
Oil & Gas Temp. Over 50 (Initial License) (3298
Oil & Gas Temp. 0-50 (Renewal)………… (3297
Oil & Gas Temp. Over 50 (Renewal)……. (3299
(999)
$
750) ..... $500.00
750) ..... $207.00
750) ..... $338.00
750) ..... $360.00
750) ..... $395.00
750) ..... $450.00
750) ..... $575.00
750) ..... $690.00
750) ..... $750.00
750) .. $1,250.00
750).....$275.00
750)..... $500.00
.00
El Paso County’s Special Event Requirements to Operate
• Submit a Colorado Retail Food Establishment License Application with the required license fee and a Special
Event Retail Food Establishment Review Form at least 10 days before the event to El Paso County Public
Health.
• All food preparation must be done at the special event within the licensed establishment or in an approved
off-site commissary, which has been approved by El Paso County Public Health. Home preparation of food
and ice is prohibited.
• Only food requiring limited preparation (i.e., seasoning, grilling, reheating, assembling finished products,
etc.) shall be prepared or served at the special event.
• Extensive food preparation (i.e., vegetable washing/cutting, skinning/cutting raw meat, forming raw
hamburger patties) shall not be done at the special event. These procedures must be completed at an
approved commissary. A food product thermometer with a temperature range from 0-220°F is required to
check food temperatures.
Cooking
Follow these requirements for the minimum uniform
internal temperatures:
• Poultry, stuffed fish, stuffed meat, stuffed pasta,
stuffed poultry, or stuffing containing fish, meat or
poultry: 165°F
• Whole cuts of pork, lamb, and beef*, as well as eggs
and all other potentially hazardous foods requiring
cooking: 145°F
• Ground meats (hamburger, sausage), or any meat or
fish, that is not a whole cut: 155°F
• Game meats of any kind: 155°F
*Rare roast beef and rare beef steak: 130°F
Holding
Potentially hazardous foods must be stored at or below 41°F (under refrigeration) or 135°F and
above (hot holding) at all times, except when undergoing necessary preparation. Room temperature
storage of potentially hazardous food is not allowed. Potentially hazardous foods found in the
temperature danger zone between 41°F and 135°F must be discarded.
Reheating
All potentially hazardous foods that have been cooked and then cooled, shall be rapidly reheated to 165° F or
more within two hours or less before being served or
placed in a hot food storage device.
Crock pots, steam tables,or other hot holding devices
are not to be used for heating up food; they are only
for maintaining hot food which has already been
heated to proper temperature. Electrical equipment
is recommended for hot holding. However, propane stove, grills, or any other heat source capable of
holding food at 135°F or above may be used as long as
it meets the requirements of the local fire authority.
Cooling
All potentially hazardous food that has been cooked or held
hot must be properly cooled if it will be reused. Food must be
cooled from 135°F to 70°F in two hours or less and from 70°F
to 41°F within an additional four hours or less.
Mechanical refrigeration is recommended, but ice chests with
ice from an approved source (i.e., bagged ice from a store)
may be used if potentially hazardous food temperatures
below 41°F are maintained. Coolants or cooling packs used as
ice substitutes are not acceptable.
Storage and Protection
• All food and clean utensils must be inaccessible to the public and protected from dust, dirt and
airborne contaminants.
• Except for open flame grills, all areas for food preparation and service must have overhead
protection. Tents or canopies may be used, but must be constructed of materials that protect the
interior of the operation.
• Sidewalls are required unless otherwise approved by El Paso County Public Health. Floors are
required, unless the establishment site is paved or installed on well-established turf.
• Approved dispensing utensils or gloves are to be provided for handling and serving food. Using
bare hands to serve ready-to-eat food is prohibited.
• An adequate supply of safe water must be provided. Events using a private water supply (such as
a domestic well) must submit acceptable water sample results. Water samples shall be taken no
earlier than 30 days prior to the event.
Handwashing Facilities/Hygiene
A handwashing facility must be available for employee handwashing. This must include at least
a continuous hands free flow of warm running water, soap, individual paper towels and a bucket
to collect the dirty water. This unit must be of adequate pressure and size to facilitate proper
handwashing.
A separate bucket of sanitizer must be present for rinsing/storing wiping cloths to be used on table
tops or counters. One capful of liquid bleach added to one gallon of cool water will be acceptable.
This should be changed frequently during the day. All utensils in continuous use must be washed,
rinsed and sanitized every four hours. If areas for washing are not available, single use utensils may
be used or several utensils may be used throughout the day, then taken to a commissary to be
properly cleaned. Sanitizer and test strips are required.
Except for clean water, liquid waste must not be dumped into streets, storm drains, or onto the
ground. Use the containers to collect dirty water and discard in a sanitary manner (i.e., public
restrooms). Chemicals such as liquid bleach or detergents must be stored away from food
preparation and display areas.
• All personnel must wear adequate hair restraints, and maintain a high degree of personal
hygiene, including careful and frequent handwashing and clean clothing.
• Smoking, eating, or drinking in any food establishment while working is not allowed.
• Unauthorized persons or animals must not be allowed within the establishment.
• Any person who has experienced diarrhea, vomiting, or fever within the past 24 hours; or who
is jaundiced; or who is infected with a communicable disease, such as a cold or flu; or who has
open sores or infected cuts on his/her hands, shall not work in any retail food establishment
until symptoms have resolved for at least 24 hours. For more information contact El Paso County Public Health
www.elpasocountyhealth.org ▪ (719) 578-3199
Find us on Facebook (El Paso County Public Health)
and Twitter (EPCPublicHealth)
Updated May 2012
El Paso County Public Health
Special Event Self Inspection Report
1675 W. Garden of the Gods Road, Suite 2044
Colorado Springs, CO 80907
Phone: (719) 578-3199 Fax: (719) 578-3188
www.elpasocountyhealth.org
Handwashing/Personal Hygiene
Handwashing station set up with soap and paper towels
Handwashing station easily accessible
Employees practice proper handwashing
(i.e. before putting on gloves, after handling trash, after returning to the booth)
Handwashing station has a basin to catch wastewater
Employees exhibit good hygienic practices
Cuts/sores properly covered with bandage and glove
Employee beverages properly covered and stored
Employees eating/drinking/smoking away from food preparation areas and clean utensils
Temperature Control
⁰
Facility is using approved hot holding equipment (electrical or propane)
Metal stem thermometer available with range of 0⁰F to 220 F, calibrated and properly used
Potentially hazardous foods held at 41°F or below or at 135°F or above
Potentially hazardous foods rapidly reheated to 165°F or higher (within two hours or less)
All potentially hazardous foods cooked to proper temperature
Ice chests and coolers have thermometers
Storage/Protection
All advanced preparation done at an approved facility (not at special event establishment)
Raw meat stored separately from other food items
All food and single-use items stored at least 6" off the ground
Ice drained from coolers frequently
Food protected from the environment and the public (i.e. food shielded, covered)
Utensils and single-use items stored inverted and protected
Chemicals labeled and stored away from food and food contact surfaces
Food stored in approved refrigerators/freezers or durable ice chests
Miscellaneous
All food from an approved commercial source
Utensils properly washed/rinsed/sanitized at commissary (no washing in food booth)
Test strips available for testing sanitizer
Sanitizer available and at the proper concentration
Comments:
04/12