MS State Department of Health

Retail Food Facility Dog-Friendly Variance Request Form

6-501.115 Prohibiting Animals

MSDH may issue a variance approval allowing pet dogs to be permitted in designated outside dining areas provided all requirements noted below are met. Please fill out all facility information and complete the checklist. Completed applications may be submitted by web form only

The Food Facility Information section must be completed in its entirety and text boxes should be used. There are no optional fields.

County:	Facility ID#:
Facility Name:
Physical Address:
City:	State:	Zip:
Mailing Address:
City:	State:	Zip:
Contact Person Name:		Title:
Email:		Phone:

Please read and understand all requirements.

1. Written procedures will be maintained at the food establishment that include:

- A diagram of the designated outdoor area for dogs;
- The establishment's procedure for assuring employees do not touch, pet, or otherwise
  handle pet dogs and for immediately cleaning accidents involving dog waste. The
  procedure must also describe the location of the materials and equipment necessary to
  clean up accidents involving dog waste; and
- c. The establishment's procedure for notifying employees and patrons of the requirements
  of this policy.

2. Other than service dogs, no dog shall be present in the interior of any restaurant or in any
area where food is prepared;

3. The food establishment shall have the right to refuse to serve the owner of a dog if the owner
fails to exercise reasonable control over the dog or the pet dog is otherwise behaving in a
manner that compromises or threatens to compromise the health or safety of any person
present in the food establishment;

4. The person in charge shall not permit dogs to physically contact food, serving dishes, utensils,
tableware, linens, unwrapped single-service and single-use articles or other food service items
that may result in contamination of food or food-contact surfaces and shall not permit animals
to physically contact employees engaged in the preparation or handling of food;

5. All tableware used for the designated outdoor area shall be restricted to single-service or
single-use articles;

6. The person in charge shall instruct employees and patrons that dogs shall not be allowed to
come into contact with serving dishes, utensils, tableware, linens, paper products or any other
items involved in food service operations. Employees shall wash hands after any contact with
dogs, dog supplies, and dog waste;

7. Patrons shall keep their dogs on a leash at all times and keep their dogs under reasonable
control;

8. Dogs shall not be allowed on tables, chairs or other furnishings;

9. Tables and chairs located in the designated outdoor area shall be easily cleanable. Cleaning
supplies and sanitizers shall be provided and stored in the designated outdoor area for exclusive
use in the designated outdoor area;

10. The person in charge shall ensure that any accidents involving dog waste are cleaned
immediately and the area sanitized with an approved product. A kit with the appropriate
materials for this purpose shall be stored in the designated outdoor area. Pet waste shall be
removed immediately, and the area shall be cleaned and sanitized;

11. A covered refuse container shall be located in the designated outdoor area and shall be used
exclusively to store all pet waste generated by the designated outdoor area;

12. The permit holder shall post signs at the entrance of all dining areas stating the facility is
dog-friendly and has a designated outdoor area for dogs, that dogs are only allowed in the
designated outdoor area, and dogs may only access the designated outdoor area from an
outside entrance; and

13. Pet dogs shall not be permitted to travel through indoor or non-designated portions of the
food establishment, and ingress and egress to the designated outdoor portions of the food
establishment shall not require entrance into nor passage through any indoor area of the food
establishment.

I hereby certify I have read and understand the requirements above, and that the information provided
on this form is true and accurate. If approved, I understand failure to comply with the requirements of
this variance may result in revocation of the variance.

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Please read and understand all requirements.

1. Pay the re-inspection fee set forth in MSDH Food Protection regulations (Title 15, Part 13,
Subpart 75, Chapter 5, Rule 5.1.1);

2. Pass a full site inspection ensuring the facility is also in compliance with the requirements
listed in this variance for pet dogs in designated outdoor areas; and

3. Agree to be classified as a Risk Level 4 facility as long as pet dogs are allowed in designated
outdoor areas at your facility due to the potential of cross-contamination and assume the costs
and inspection frequency associated with a Risk Level 4 facility.

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Date:

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M-D-Y

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