SPECIAL EVENT PERMIT APPLICATION
Any individual or group planning to organize and/or operate an event (indoors or outdoors)
where persons may gather for the consumption of food and/or beverages shall notify the
NORTH BAY PARRY SOUND DISTRICT HEALTH UNIT by completing this application a minimum
of 15 days prior to the event.
Event Information:
Name of Event:
Date of Event:
Location of Event:
Concession Operator Information:
Name of Applicant:
Telephone:
Fax:
Address:
Person in Charge of food handling:
Address:
Telephone:
Fax:
Number of people attending:
Food Service:
Food Product to be served:
Foods served:
 Catered
 Pre-packaged
 Fully cooked and prepared on-site
 Prepared and cooked at another location, hot/cold hold and assembled at site.
Address of other location
Source of food:
Cooking facilities:  Barbecue
Hot hold equipment
 Other (identify)
 Yes
 No
Refrigeration facilities:  Mechanical
Type:
 Ice & cooler  Other (identify)
Serving utensils:  Single service disposable  Multi-use
Running water from approved source:
 Municipal hook-up  Holding tank
 Other (identify)
Hand washing facilities available at site  Yes  No
Protection against contamination (wind, rain, insects, human contact):  Canopy
 Self-contained
Number of Anticipated Attendees:
Seating Area for Food/Beverage Service:  No
Washroom Facilities Available:
 Yes
 On site
 Portable privies
The following conditions/recommendations are to be completed before the event is allowed to commence:
Criteria for special events provided to vendor
 No
 Yes (see attached)
or

Applicant Signature
Public Health Inspector
Date (yyyy/mm/dd)
This application is –
Date (yyyy/mm/dd)
 APPROVED
 NOT APPROVED
(See Over)
Washroom Requirements
Where seating is available:
Toilets per sex
Washbasins per sex
3
3
2
2
4
1
Toilets per sex
Washbasins per sex
1 – 600 persons
600 – 1200
3
3
2
4
For each additional 600 persons
2
1
1-600 Persons
600-1200 Persons
For each additional 160 persons
Non-seating events:
*Seating is based on 1.12 square metres (12 square feet) per person.
Where portable toilets (privies) are utilized for washroom requirements, they shall be:
a)
Constructed to ensure privacy, protection from the elements, supplied with a toilet
seat and vented to the outside
b)
Supplied with toilet paper, garbage receptacle and deodorizer
c)
Cleaned and disinfected daily or as necessary
d)
Handwash facilities should be provided for public use in conjunction with sanitary
facilities. Packaged, moist hand towelettes or sanitizer should be provided in the
privies without running water and at all food concessions.
e)
Designated for male and female use, and
f)
Adequate lighting and directional signs shall be provided
“The personal information being collected on this form is collected under the authority of the Health Protection and Promotion
Act and the Municipal Freedom of Information and Protection of Privacy Act. This information shall be used to ensure
necessary health care measures are attained. Questions covering the collection of this information may be directed to the
North Bay Parry Sound District Health Unit, 681 Commercial Street, North Bay, Ontario, P1B 4E7. Phone: (705) 474-1400.”
Revised October 2006