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Certified Food Manager – Statement of Fact
Submit one copy per CFM. Make additional copies of this page for additional CFMs if any or to submit any changes in the CFM or CFM’s work hours.
I am a Certified Food Manager registered with the Ashland Board of Health. I agree to notify the Ashland Board of Health in writing if I am no longer associated with this establishment as a Certified Food Manager or if my total number of hours of work per week at this establishment changes. By filling out this form, I certify under penalties of perjury that all information is true to my knowledge.
Permit for year 2018 (Rev. 9/29/2017)
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