Food Allergy & Dietary Accommodation Form

Dietary Restrictions
Which of the following dietary needs do you have? (check & indicate the ones that apply)
Please indicate your allergy? (Check all that apply)
Do you have an anaphylactic response to any of the above allergens?
Do you carry an epinephrine device (EpiPen)?
Would you like to meet with the on-site Registered Dietitian, Food Service Manager and/or Executive Chef?

Disclaimer:

When ordering food, you are responsible for identifying as an individual with food allergies or special dietary concerns. When visiting our campus food service locations, you must be diligent about your food safety as Fresh Food Company does not prepare food in an allergen-free facility, and we have many open kitchen environments, so there is always a risk of cross-contamination.

We advise you to speak with a Chef or Manager and “Ask Before you Eat” before making your meal selection if you have any questions or concerns about a particular food option.

Food service staff receive regular food safe handling and procedural training to help minimize the chance of adverse reactions.

UTSC Food Partnership understand the severity of food allergies and take a team approach when preparing meals for those with any/all allergies to avoid cross-contamination that may cause adverse reactions.

UTSC Food Partnership does not guarantee any given food items will be completely free of a specific food allergen. Foods and ingredients sourced from off-site manufacturers could change without our knowledge; therefore, we cannot assume any liability for adverse reactions.

Although UTSC Food Partnership make every effort to identify ingredients and avoid crosscontamination, it is your responsibility as a student with a food allergy or dietary need to self-identify and ask for assistance when ordering food.

I am aware of, and understand the risks of eating at food service locations on campus as a student with a food-related allergy or special dietary requirement. I will be diligent in managing my diet and carry my epinephrine device (EpiPen) at all times (for those with anaphylactic allergies).

Sign above
If the student is under 17, parent/guardian's signature is required:
Sign above

 

The personal information you provide through this form will be used for the purpose(s) of triaging your accommodations. The information collected through this form will only be accessed by the onsite dietician with ARAMARK who need it for the purposes set out above. If you have any questions about how the information you provide through this form will be used please contact Billi Jo Cox, 416-287-7384