EXCELLENCE IN FOOD
SAFETY AWARDS

Name of Establishment

Permit Number

Person to Contact

Phone Number

Requirement Checklist (select all that apply)

As the person in charge of the above establishment, I certify that:

The establishment is currently open and possesses a valid health permit

The permit has not been suspended or revoked during the application year

The establishment has been inspected in accordance with frequency requirements (Risk category 1’s and 2’s – once per year, category 3’s – twice per year)

The establishment had had no more than 1 repeat violation during the last 2 years.

The establishment has at least 1 Certified Food Protection Manager (CFPM)

CFPM name

Certificate Number

Certifying Organization (i.e. ServSafe, etc.)

Expiration date

Supporting Documentation (submit 3 of the 6)

Approved HACCP plan

Proof of food safety logs (temperature, cooling, calibration)

Proof of continuing education for staff, including attendance at trainings or conferences

Written food safety plan or internal training program

Essay (minimum of 500 words) – How has your establishment promoted a culture of food safety excellence this year?

Approved Operational Plan (i.e. Dogs on Patio, Catering, Barbeque)

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All supporting documentation must be submitted with application.

Application must be submitted between November 1 and December 31.

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EXCELLENCE IN FOOD SAFETY AWARDS

EXCELLENCE IN FOOD
SAFETY AWARDS