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2. Name of Event*
3. Date & Time of Event*
4. Location of Event/Booth*
6. Name of Concession (Business Name)*

   If you are a permitted food establishment in another Town/City, you MUST submit a copy of your permit with this application.

7. Phone #*
9. Business Address*
   Street Address, Town/City, State & Zip Code
11. Name of Business Owner*
12. Owner Phone #*
14. Email of Business/Owner*
16. Name of Person in Charge (PIC) of food safety at the event*
17. PIC Phone #*
18. PIC Email*
20. Does the PIC have a Food Manager Safety Certification? If yes, submit copy to healthdept@winchester.us, fax to 781-729-1794 or mail to Health Dept., 71 Mt. Vernon St, Winchester MA 01890*
    -- Select One --YesNo
22. Will you be cooking on-site? *
    -- Select One --Yes No
24. If yes, how will food be prepared (grill, steamer, etc)?*
    NOTE: PROPANE TANKS AND GENERATORS REQUIRE FIRED DEPT. APPROVAL.
26. If no, where will food be prepared, cooked and stored priort to event? Include Name of Establishment, Address and Phone #.*
28. How will you keep cold foods cold (41°F or less)?*
30. How will you keep hot food hot (135°F or more)?*
32. Will you be reheating previously cooked food? Yes or No.*
34. If yes, what food and how?
36. Describe the handwashing facilities in your concession:*
38. How will you avoid bare hand contact with food?*
40. What is your plan if any of your food service utensils falls on the floor or ground, how will you wash and sanitize it?*
42. List all food and beverage items that will be served:*
44. Where will food be stored prior to event?*
46. Will you be offering samples? If yes, describe your set up:*
48. If there is not a certified food manager that will oversee this concession, the operator must read "Temporary Food Concessions" handout. By receiveing a Temporary Food Concession Permit, the operator agrees to abide by this document.
50. All required documentation can be submitted to healthdept@winchester.us, mailed to Health Dept., 71 Mt. Vernon St, Winchester, MA 01890, or faxed 781-729-1794. Permits will not be issued until all required information is received.
52. Applicant Signature*
    Once name is typed in, it will be considered an electronic signature.
53. Date*
55. Payment Options
    Payment must be made before a permit will be issued. To pay online click below, or a check payable to "Town of Winchester" can be mailed to: Winchester Health Dept., 71 Mt. Vernon St, Winchester, MA 01890
57. Online Payment
    TOWN DAY Temporary Concession Permit

    Once online payment is complete, you need to return to this page and “submit” application.
Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit

* indicates a required field