University of Wisconsin-Green Bay
Non-Standard Food Event Authorization (NSFEA)

Instructions: Please refer to the UWGB Food Event Policy before completing this form. This form must be submitted to the Campus Contract Administrator at least 14 days prior to the event. The food aspects of the event cannot take place until authorization is approved.

Event, Contact and Funding Information

Organization Name

Date Filed

Event Contact Name
 Phone #
Address
 Fax #
Name of Event
 Date of Event
Location of Event
 Time of Event
E-Mail Address
Type of Event
University
Public
Private Affair

Funding Source
University/State
Agency
Personal

 Amount?
Food Source and Safety Information
1. List the foods you will be serving, selling, or giving away at the event
2. List the name (s) and adress (s) of the food source. How will food be transported?
3. Who will be the food handlers and servers?
4. Check equipment and practices that will be used to ensure food safety?
Disposable Gloves Serving Utensils
Hair Nets/hats Disposable Utensils
Food Thermometer Hand Washing (location?)
Documented temperature
       every 1/2 hour of service

5. How would you prefer to be informed of your approval or disapproval?

E-Mail
Fax

If your Non-Standard Food Event Authorization (NSFEA) form is approved, the Event Contact is responsible for ensuring compliance with safe handling of food, all other Food Event Policy guidelines, any comments to be addressed above as the event proceeds, and must refer to the educational materials and documents attached to ensure food safety.

If your Non-Standard Food Event Authorization (NSFEA) form is disapproved, it may be for the following reasons (which will be listed in a response); lack of information, food source, transporting, handling/servers, type of food, etc.