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Notification, Registration or Renewal of a Food Business Form
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Environmental and Public Health
Food Businesses
Notification, Registration or Renewal of a Food Business Form
Required fields are marked with an asterisk (
*
).
Part 1: Type of Application
Type of Application
*
I am notifying my intention to operate a food business (s84)
I am applying to register a food business (s87)
I am applying to renew a food business’ registration (s89)
Part 2: Type of Business
Type of Business
*
The food business is a one-off event
The food business is an ongoing business
The food business is mobile food business
The food business will operate from fixed premises
Part 3: Food Business Proprietor's Details
Applicant’s Full Name (Name of the individual or company that will carry on the food business)
*
ABN/ACN
*
If you are a non ABN/ACN holder, Enter your Date of Birth
Business Address
*
Postal Address (If different from business address)
Business Phone Number
Mobile Phone Number
*
Email Address
*
Part 4a: Food Business Details
Trading Name
*
On-Site Contact (If different from applicant)
Phone Number
Email Address (On-site contact)
Attach a copy of your Food Safety Supervisor Certificate (If Applicable)
Part 4b: Hours of Operation
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Part 4c: Mobile Food Business Details
Vehicle Registration Number (if applicable):
Address where vehicle is garaged, or equipment is stored:
Proposed Start Date of Trading:
Part 5: Food and Food Handling Activities
List of foods to be sold
List of foods to be sold (a menu or produce list may suffice)
Types of food handling activities or processes to be used
*
No processing
Cooking
Cooling
Reheating
Hot-holding/Cold-holding
Cook-chill / Sous vide
Vitamising
Packing / Repacking / Labeling
Vacuum Packing
Preparation in advance (> 4 hours)
Other food handling activities (if any)
Part 6: Food Business Layout - Mobile Food Business
For mobile food businesses: please attach an A4 plan or photographs clearly depicting the layout of your vehicle, cart, tent, booth or other mobile structure. Refer to the Guidelines for Mobile Food Businesses for more information
Part 7: Food Preparation & Storage - Mobile Food Business
If any food sold from a mobile food business is to be prepared and/or stored at another location not mentioned above, please provide details, including the address of any premises where food is to be stored or prepared.
Part 8: Application Declaration
I declare that the information provided on this form is true and correct. I understand and agree that information on this form, and about the business and its on-going operation, may be shared between Authorised Officers, councils and other jurisdictions to assess this application and the business’ compliance with the Food Act 2003.
*
I consent to receiving communications about this application in electronic form
Applicant Name