40 Main Road Receipt No:... PO Box 210 HUONVILLE TAS 7109 Date:... Phone: (03) Licence No:...

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1 HUON VALLEY COUNCIL FOR OFFICE USE ONLY 40 Main Road Receipt No:... PO Box 210 HUONVILLE TAS 7109 Date:... Phone: (03) Licence No:... PLEASE USE BLOCK LETTERS ALL SECTIONS MUST BE COMPLETED TO ENSURE PROCESSING OF APPLICATION NOTIFICATION of Food Business / ANNUAL FOOD REGISTRATION Application (including mobile food business) 1. Applicant Details for Registration Name (person) Food Act 2003 Sections 87 & 88 Sole trader/partnership... Company ACN number... Other please detail... Correspondence address Suburb Post Code Telephone Mobile address Details of food safety qualifications Details of food handling training/experience 2. Premises and Operational Details Trade name of premises Premises address Suburb Post Code Telephone Mobile address Emergency Contact MOBILE FOOD VANS Vehicle Rego number & address where garaged Telephone

2 Type of business Childcare Aged Care Restaurant/café Takeaway Catering Butchery Bakery Processor/Manufacturer Other please detail... Proposed hours of operation (including attendance on site when the business may be closed to patrons) Waste water system Sewage Other(please specify)... Water supply Town water Other(please specify)... Does the premises have a grease trap? YES NO 3. Food please describe in the space provided & include menu with application Types of food (Please provide as much detail as possible) Meat products Dairy products (including cream) Seafood Processed fruit/veg & juice Raw Egg Products (e.g. aioli, hollandaise) *NB these products will require compliance with DHHS Manufacturing Controls for Raw Egg Products 2008 Council to assess Cooked rice/pasta Baked goods Other processed/manufactured foods Pre-packed foods Whole fruits/vegetables Other 4. Food Safety Program/ Food Safety Management Statement Does the premises/business have a Food Safety Program or Food Safety Management Statement? (If you are unsure whether your business should have a FSP or FSMS please contact Council s EHO to discuss.) Yes please provide details and attach supporting documents you are not required to provide information for this section

3 5. Details of New or Altered Premises Has a fit out of an existing premises been conducted in the last 12 months? Is the application for a newly constructed premises? Yes please attach floor plan and specfications you are not required to provide information for this section Yes please provide Occupancy Certificate and Form 50 with this application you are not required to provide information for this section 6. Other Information Do you offer any catering services as part of your business? Food production in the Huon Valley is growing. Council has many enquiries regarding the availability of commercial kitchens for lease. Do you have a commercial kitchen that you would be interested in leasing? Would you be interested in receiving Council s Food E-Newsletter? Yes Please provide a short explanation. Council s EHO will be in contact to discuss Yes Council will contact you Yes please provide your address: Municipal Events and Markets Registration Council offers an annual events registration for holders of annual food registrations who sell potentially hazardous foods. For an additional annual fee* you may apply for registration to cover attendance at all events/markets within the municipal area. Please note that approval from event and market coordinators is required and participation is not determined by Council. *Please contact Council s Customer Service Centre on for fee information. Yes please complete additional information on the two pages at the end of this application. (*NB: You will be sent an invoice for this fee. Once payment is received a Certificate of Registration will be issued.)

4 8. Fees and Payment Application fee Payment options $ In person: Cash, cheque, credit card, EFTPOS Mail: Cheque Huon Valley Council Customer Service Centre 40 Main Street Huonville TAS 7109 Mail to: Huon Valley Council PO Box 210 Huonville TAS 7109 Monday Friday 8.30am 5.00pm Telephone: Credit card (Visa, MasterCard) Call (03) Monday - Friday 8.30am 5.00pm Credit Card (Visa, MasterCard) Card type: Visa MasterCard Card Number: Expiry Date: / 9. Declaration and signature I understand that this application will be assessed on the information provided and that it is my responsibility to inform Council of any changes. Not doing so may result in breach of the Food Act In the event that this application is approved and registration granted, the registration will be valid only for the information provided in this application. I understand that under the Food Act 2003 Council has a responsibility to ensure safe food handling and sale. Council may inspect any premises associated with the production/sale of food for the registered business. This includes but is not limited to the premises, vehicles and event stalls. I understand that Council is not required to provide notice of any inspections. Signature of applicant for registration... Date: / / OFFICE USE ONLY COUNCIL ASSESSMENT NOTES: Approved by: tification only Registration required Signature: Date: / /

5 Annual EVENTS REGISTRATION (for permanent registered food premises only) Food Act 2003 Sections 87 & 88 Please complete the following questions AND provide a floor plan as to how your Temporary Food Stall is likely to be set-up. Types of food to be provided at events. (Please provide as much detail as possible) *Please note: Council does not permit the manufacture or sale of raw egg products at Temporary Events How is food transported to the event/site? How will temperature control of potentially hazardous foods be met? How will temperatures be monitored during the event/market? How will utensils and equipment be cleaned/ sanitised during the event/market? How is waste water managed during the event? Meat products.. Dairy products (including cream).. Seafood.. Processed fruit/veg & juice.. Cooked rice/pasta.. Baked goods.. Other processed/manufactured foods.. Pre-packed foods.. Whole fruits/vegetables.. Other.. Supplier Refrigerated vehicle Insulated vehicle Esky with ice bricks Wrapped/lidded containers Other... Refrigerator Esky with ice bricks Cool room Bainmarie Pie warmer Cooked to order Other... Digital thermometer Probe thermometers Shelf thermometers Portable sink Kitchen nearby (please identify location on site plan) Buckets of hot water Taken back to registered kitchen (please demonstrate there will be adequate clean utensils for the duration of the event) Sewer outlet at registered premises Waste dump point Liquid waste holding tank Other... PTO...

6 *NB: Hand washing facilities must be provided. At minimum this must include: potable warm running water, a container to catch wastewater, liquid soap and single use paper towel, as detailed in the Guidelines for Temporary Food Stalls issued by the Department of Health and Human Services. In the space provided below, please provide a detailed site plan of the stall showing layout of all equipment (including hand washing facilities, fridges, freezers, LPG bottles, etc) in accordance with the Guidelines for Temporary Food Stalls. PLEASE NOTE: The scope of this registration includes all markets and events within the Huon Valley municipal area. This registration may not be accepted in other municipalities. This application will be considered by Council s EHOs and, if approved, your registration may be conditioned. You will receive an additional Certificate of Registration to your annual Food Business Registration. This Registration must be taken to, and displayed at, all events. All foods must be prepared within the registered premises (permanent kitchen); This application will not be considered unless the floor plan is completed above (or attach separate drawing). The stall must be set-up in accordance with this floor plan at each event. For further information please do not hesitate to contact Council s EHO on

7 A GUIDE TO COMPLETING THIS FORM NOTIFICATION / ANNUAL FOOD REGISTRATION 1. Applicant details for Registration Provide Council with the name of the person who will be responsible for the registration. This may be an owner or a manager. 2. Premises details Provide Council with details about the premises infrastructure. 3. Food Please provide as much detail as possible about foods you provide. If possible, attach your menu. *Please note: the preparation and storage of raw egg products must comply with strict manufacturing controls developed by DHHS. 4. Food Safety Program / Food Safety Management Statement The following food businesses required a food safety program / food safety management statement (FSP/FSMS). Council may also require other businesses to provide a FSP or FSMS. Food service in which potentially hazardous food is served to vulnerable populations (e.g. nursing homes); Producers of manufactured and fermented meats (including ready-to-eat meats). 5. Details of new or altered premises This section is to be completed if alterations have been made, such as an internal fit-out or if a new premises is being built. 6. Other information Please complete this if you intend to offer any catering services as part of your business, would like to participate in the commercial kitchen registry and/or receive Council s food newsletter. 7. Municipal Events and Markets Registration Council offers an annual events registration. It is open to Huon Valley Council s annual registered food businesses who sell potentially hazardous foods and have a permanent temporary site which is transported to Huon Valley municipal events and/or markets. This enables you to attend events/markets without having to apply for temporary food registrations. Please note this will only cover you for one site per event - if you intend to have multiple sites, additional sites will be subject to standard temporary food application fees. 8. Payment This section details payment options. 9. Declaration and signature Without signature(s) the application will not be processed. ANNUAL EVENTS REGISTRATION Types of food Please provide as much detail as possible about foods you intend to provide at events. Transportation, temperature control, waste water, etc Please answer all questions and provide detail where required. Site plan A detailed site plan (floor plan) of the stall is required. Please ensure this plan meets the requirements of the Guidelines for Temporary Food Stalls (available on Council s website).