HomeBasedFoodBusiness.docx / Building and Environmental Health / Nov-21 Page 1 of 2
Customer Service | 1300 292 872 | (02) 6670 2400
O Box 816 Murwillumbah NSW 2484
ABN 90 178 732 496 | tsc@tweed.nsw.gov.au | www.tweed.nsw.gov.au
Application for Home Based Food Business (Home Occupation)
A1. Application Details
Contact No. Email
Driver Licence No. State of Issue
A2. Food Type
Low Risk Preparation of non-potentially hazardous products for retail (tea, honey, etc.).
Preparation of potentially hazardous products for retail (baked goods, meals with
meat/dairy products, products which will be further prepared at a market or event).
If you are intending to only sell food to other businesses, such as cafes, restaurants and
supermarkets you will need to contact the NSW Food Authority food.contact@dpi.nsw.gov.au
or 1300 552 406.
A3. Food Safety Supervisor (FSS)
A FSS is required to retail food businesses who prepare and serve food for sale that is:
Potentially hazardous (needs temperature control) and
Not sold or served in the supplier’s original package. (See website for more information:
Not Required
Required Name Certificate No
Expiry Date
Select >>
Application for Home Based Food Business (Home Occupation)
Page 2 of 2 HomeBasedFoodBusiness.docx / Building and Environmental Health / Nov-21
A4. Business Details
Business Trading Name
Description of the business and
type(s) of food being produced
(e.g. fruit jams prepared at
home and sold as packaged
product at markets).
Other than yourself, how many
people will be employed?
Are you the owner of
the property?
Yes No - please provide written permission from the owner.
Is the property
connected to Town
Water supply?
Yes No -
Is the property
connected to
Council Sewer?
Yes No
A5. Plan of Home Based Food Business
Please provide a diagram or photos of your home kitchen/food business, which show:
Separate hand wash basin (must be easily accessible);
Double bowl sink OR single bowl sink with dishwasher (cleaning and sanitising);
Food preparation area;
Cold storage; and
Floors, walls and ceiling etc
A6. Privacy and Personal Information Protection Notice
I declare that all the information in this application is true and correct.
Some information requested by Council for this form constitutes personal information under the Privacy and
Personal Information Protection Act 1998 (NSW).
Purpose of Collection: For Council to carry out certification work for the applicant.
Intended Recipients: Council staff, Government agencies.
Supply: Legally required, Council may not be able to accept your application if information is not provided.
Right of Access / Correction: Contact Council (02) 6670 2400 or email tsc@tweed.nsw.gov.au
Storage details: Tweed Shire Council, 10-14 Tumbulgum Road, Murwillumbah NSW 2484.
Consequence of non-provision of information: Failure to provide correct business details is a breach of the
Food Safety Standards.
Applicants Name Date