Get Massachusetts Food Establishment Permit Application Department Of Health Form

Filling out the Massachusetts Food Establishment Permit Application is an essential step for food establishments seeking to operate legally in the state. This guide will provide clear, step-by-step instructions to help you complete the form efficiently online.

Follow the steps to complete your application accurately.

1. Press the ‘Get Form’ button to retrieve the Food Establishment Permit Application and access it for completion.
2. Begin by entering the establishment name in the designated field at the top of the form.
3. Provide the establishment address, ensuring that all details are accurate and complete.
4. If the mailing address is different from the establishment address, fill in the establishment mailing address where indicated.
5. Input the establishment telephone number in the corresponding field.
6. Enter the applicant's name and title; ensure this reflects the person responsible for the application.
7. Fill in the applicant's address and telephone number, vital for communication regarding the application.
8. Record a 24-hour emergency contact number for the establishment, which is required in case of emergencies.
9. If the owner differs from the applicant, provide the owner's name, title, and address accordingly.
10. Indicate the ownership structure of the establishment by checking the applicable option – an association, corporation, individual, partnership, or other legal entity.
11. If applicable, list the name, title, and home address of any officers or partners of the corporation or partnership.
12. Detail the person directly responsible for daily operations, including their name, title, and contact information.
13. If necessary, provide the name and contact information for the district or regional supervisor.
14. Select the appropriate water source by checking either 'private well' or 'town system'.
15. Check the sewage disposal method, choosing between 'town sewer' or 'on-site septic'.
16. State the days and hours of operation for the establishment.
17. Indicate the number of food employees working at the establishment.
18. List the name(s) of individuals certified in food protection management, and attach relevant certification documents.
19. If applicable, identify the person trained in anti-choking procedures if there are 25 or more seats.
20. Choose the establishment type, marking all that apply, including different food service categories.
21. Indicate if the establishment is a permanent structure or mobile.
22. Determine the length of the permit required, selecting the appropriate option: annual, seasonal, or temporary.
23. Outline the specific food operations carried out by checking all applicable categories.
24. At the end of the form, affirm the accuracy of the information provided by signing as the applicant and date the signature.
25. Once all fields are completed, save changes, download, print, or share the form as necessary.

Complete your Massachusetts Food Establishment Permit Application online today to ensure compliance with local health regulations.