1. No category

Environmental Health Services
1035 First Ave. West Kalispell, MT 59901
(406) 751-8130 Fax: 751-8131
Community Health Services
751-8110 FAX 751-8111
Environmental Health Services
751-8130 FAX 751-8131
Family Planning Services
751-8150 FAX 751-8151
Home Health Services
751-6800 FAX 751-6807
WIC Services
751-8170 FAX 751-8171
Animal Shelter
752-1310 FAX 752-1546
Flathead City-County Health Department
Temporary/Mobile Food Purveyor Plan Review Form
Establishment Name:
Owner Name:
Physical Address:
Physical City, State & Zip:
Legal (Sec-Twn-Rng-Trc):
Telephone & Fax:
Mailing Address:
Mailing City, State & Zip:
Office use only:
Plan Review Fee:
Amount Paid:
Date of Payment:
Payment Method (Cash, Check #, etc.):
Receipt #:
Providing quality public health services to ensure the conditions for a healthy community.
Fee Schedule
Type
Non-Profit
Temporary
Mobile
Cost
Waived
$25
$90
Mobile or Temporary Food Purveyor Plan Review Form
This form must to be completed and submitted for Flathead City-County Health
Department approval prior to beginning construction, remodeling or a change of menu.
Please complete the entire form – if any blank or question is left unanswered (not
applicable may be an acceptable answer in some cases), the plan review will be
considered incomplete and immediately denied.
Required Documentation:
1. Temporary and mobile food service operations are required to have a commissary
servicing area for various purposes including filling potable water, dumping waste water,
cleaning, storage, etc. A signed commissary agreement form must accompany this
application.
2. A proposed menu for the operation must be submitted with this application. In addition to
major menu items (i.e. hamburgers, hotdogs, etc.), the menu should include toppings
(i.e. shredded lettuce, sliced tomatoes, etc.), condiments (i.e. ketchup, relish, chili, etc.)
and beverages (i.e. canned/bottled soda, fountain drinks, etc.).
3. A diagram or floor plan of the operation including equipment locations, sink locations, the
type of overhead cover that will be used (i.e. canopy, tent, enclosed trailer, etc.), the type
of ground cover (flooring) to be used and the type of wall covering that are present.
Desired opening date: ______________________
How much water will be available on-site? __________gallons
Potable water must be obtained from an approved source. Where will potable water
tanks/containers be filled? _______________________________________________________
Waste water, including grey water from hand washing must be collected and disposed of in an
approved treatment system. Where will waste water be disposed?
____________________________________________________________________________
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Food Workers:
1. Only authorized individuals that are essential to the operation are allowed in food service
areas. Do you understand and intend to comply with this requirement? Yes / No
2. Food service workers, including yourself will be expected to be knowledgeable about
safe food handling practices including, but not limited to: safe food temperature controls,
good hygienic practices, safe food storage and proper sanitizing. How will food service
workers be trained?
______________________________________________________________________
______________________________________________________________________
3. Food service establishments must have a policy regarding ill workers or workers that
have cuts/lesions? Please describe or attach the policy:
______________________________________________________________________
______________________________________________________________________
4. Food workers, including yourself, are expected to maintain a high level of personal
hygiene. Activities such as smoking, applying makeup/hair spray, eating or drinking from
an open top container are not permitted in food service areas. Hair must be adequately
restrained. Jewelry on wrists and hands must be limited to a simple wedding band.
Please indicate how compliance with these items will be ensured or attach written policy
(if applicable):
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
5. How will adequate hand washing be accomplished and monitored?
______________________________________________________________________
______________________________________________________________________
6. Direct bare hand contact with food must be minimized. What methods will be used to
ensure this standard?
______________________________________________________________________
______________________________________________________________________
7. Personal articles such as coats, boots, umbrellas, purses, cell phones, etc. must be
stored away from food preparation and storage areas. Where will these items be stored?
______________________________________________________________________
Food:
1. Food must come from an approved/licensed source. Where will food supplies be
purchased?
______________________________________________________________________
______________________________________________________________________
2. Food supplies must be free of spoilage or adulteration. How will this standard be
ensured?
______________________________________________________________________
______________________________________________________________________
3. Food must be stored in food grade containers and must not be stored on the ground.
Describe how food will be stored prior to, during and after service.
______________________________________________________________________
______________________________________________________________________
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4. Food requiring refrigeration (meat, dairy, some opened condiments, etc.) must be kept at
41oF or lower to prevent the growth of pathogens. How will food that requires
refrigeration be kept cold? How will this be monitored? Note: Ice chests can accomplish
this for short periods, but cannot be relied on for long term storage (greater than 4
hours).
______________________________________________________________________
______________________________________________________________________
5. Raw animal products (beef, pork, poultry, fish, eggs) must be stored and handled to
prevent cross-contamination with ready-to-eat food. How will this be ensured?
______________________________________________________________________
______________________________________________________________________
6. If the menu requires food to be thawed prior to preparation, how will this be
accomplished? __________________________________________________________
7. Are there any food items that require advanced preparation (sliced/diced tomatoes,
shredded cheese/lettuce, etc.). Please describe:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
8. Cooked food that is held hot for delayed service must be maintained at a temperature of
135oF or higher to prevent growth of pathogens. How will food that requires hot holding
be kept hot? How will this be monitored? Note: residential crock pots have been found to
be inconsistent at maintaining proper temperature and are not approved for commercial
food service.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
9. A calibrated probe thermometer is required to measure cooking and holding
temperatures. Describe how your thermometer is calibrated.
______________________________________________________________________
______________________________________________________________________
10. If any food items will be cooled and reheated, please describe the cooling and process.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Cleaning and Sanitizing:
1. An approved food-safe sanitizer at a safe and effective concentration must be available
at all times of operation. Please describe the product and concentration to be used. How
will the concentration be measured?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
2. Describe where and how dishes and/or utensils will be washed and sanitized.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
3. How will solid waste (trash) be stored and disposed?
______________________________________________________________________
______________________________________________________________________
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Approval of these plans and specifications by this Health Regulatory Authority does
not indicate compliance with any other code, law, or regulation that may be
required—Federal, state, or local. It further does not constitute endorsement or
acceptance of the completed establishment (structure or equipment). A preopening inspection of the establishment with equipment will be necessary to
determine if it complies with the local and state laws governing food service
establishments.
STATEMENT: I hereby certify that the above information is correct, and I fully understand that
any division from the above without prior permission from this Health Regulatory Office may
nullify this approval.
Signature(s): _______________________________________________________________
_______________________________________________________________
Owner(s) or responsible representative(s)
Date: ________________
For Office Use Only
Sanitarian sign off:____________________________________________________________
Letter ___ Phone ____ E-mail: ____ Date of Approval ___________________
Denial Date: _____________________
_____________________
_____________________
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VARIOUS IMPORTANT CONTACTS
BUILDING DEPARTMENTS
Kalispell
201 1st Avenue East – Kalispell
(406) 758-7730
Columbia Falls
130 6th St West – Columbia Falls
(406) 892-4349
Whitefish (Building, Planning, & Zoning)
PO Box 158
510 Railway St – Whitefish
(406) 863-2410
State Building Inspector
Steve Clark
(406) 439-2982
State Plumbing/Mechanical Inspector
Building Codes Bureau
Dave Micone
PO Box 10096 – Kalispell
(406)752-5117, (406)439-4106
PLANNING / ZONING
Flathead County Planning
1035 1st Ave West
Kalispell MT 59901
(406) 751-8200
FIRE
Deputy State Fire Marshall
Dawn Drollinger
445 Main Street – Kalispell
257-2584
Kalispell
201 1st Ave E
Kalispell, MT 59901
(406) 758-7732
LIQUOR LICENSING
Liquor Licensing Bureau
P.O. Box 1712
Helena, MT 59604-1712
(406) 444-6900
FAX: (406) 444-0722
WATER SUPPLY
Department of Environmental Quality
655 Timberwolf, Ste 3
Kalispell, MT 59901
(406) 755-8985
Well Log Data:
http://mbmggwic.mtech.edu/sqlserver/v11/menus/menuData.asp
FOR FOOD MANUFACTURING:
MT DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES
ATTN: Jeff Havens
(406) 444-5302 or [email protected]
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