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Before you start, let’s check that you have
everything you need:
Read these notes before you start lling
out the form.
The completed Scope of Operations description that ts your National Programme level. This is included in this
document or please submit the completed Scope of Operations form from the MPI online tool, to nd where you t
www.mpi.govt.nz/food-safety/food-act-2014/my-food-rules/
• This form must be used when applying to Council for registration of a National Programme under section 83 of the
Food Act 2014.
• The National Programme is designed for lower and medium risk food businesses. It means you don’t need to use
written food control plans, but you must register your business, meet food safety standards, keep some records, and
get checked. Guidance documents explain what the law requires and what records must be kept and what a verier
will check, these can be found at www.mpi.govt.nz/food-safety/food-act-2014/national-programmes/
• Some information provided will be included on the public register, however, you can ask for certain personal
information to be withheld from the published register.
You can view the public register here: www.foodsafety.govt.nz/registeres-lists/
• Please ensure that you are proactive and that any building you may be using complies with the Building Act 2004 and
the District Plan rules. If you are using your home for your operation you will need to email: services@qldc.govt.nz
• Send the completed application form together with the other requirements above to:
Queenstown Lakes District Council, Private Bag 50072, Queenstown 9348
Or email to: services@qldc.govt.nz
• If there are any changes to the details provided in this application after the application has been sent to QLDC you
must promptly inform us of the changes. There is a form on our website that must be completed to advise of these
changes: www.qldc.govt.nz/services/environmental-health/food-safety-guidelines#forms-downloads
• If you require any further assistance to help with understanding what is required, please contact the duty
Environmental Health Support or the duty Environmental Health Ofcer (EHO) by phone on 03 441 0499.
An internal layout plan of all food rooms detailing layout of all xed appliances, plumbing, ventilation, lighting etc.
Page 1/11 // December 2020
APPLICATION FOR
NATIONAL
PROGRAMME 1
Under Food Act 2014
If your business is a registered limited liability company, a copy of the Company Registration Certicate.
A copy of the site plan for each address identifying physical boundaries.
DETAILS OF THE ENTITY/PERSON APPLYING FOR THE NATIONAL PROGRAMME REGISTRATION (RECORD INDIVIDUAL
SITE(S) IN SECTION 3)
Please enter the details of the entity/person responsible for this registration. These details will be used for all correspondance.
This contact must be the Legal Contact who is responsible for the business.
Single site application
Multiple site business. (A multiple site business is where the business
has more than one address where food is prepared, stored or traded,
and you would like to register all sites under one application).
Legal name of entity / person:
Postal address:
Phone:
Email*:
If you have New Zealand Business Numbers (NZBN), provide them here.
If you want more information about NZBN’s, including how to get one, see
www.companiesofce.govt.nz/about-us/what-we-do/new-zealand-business-number-nzbn
Please provide your NZBN:
BUSINESS
(tick as appropriate)
LEGAL NAME(S) OF
ENTITY / PERSON REGISTERING:
(e.g. registered company, partnership
or individual)
ENTITY/PERSON REGISTERING
NZ BUSINESS NUMBER(S):
Name:
I have attached a copy of the letter conrming my nominated
Verication Agency. A copy of your National Programme registration
approval and certicate will be emailed to your nominated third party
auditor once approved.
NAME OF VERIFICATION
AGENCY:
(QLDC may contact your Verication
Agency directly to clarify any issues
related to your registration)
VERIFICATION AGENCY DETAILS (IF NOT QLDC)SECTION 2
BUSINESS DESCRIPTION
Please provide a brief summary about
the size and scope of your food
business and what you plan to sell.
*By entering an email address you consent to being sent information and notications electronically
DATE OF OPENING:
DETAILSSECTION 1
Private Bag 50072, Queenstown 9348
10 Gorge Road, Queenstown 9300
47 Ardmore Street, Wanaka
P:
QUEENSTOWN 03 441 0499
P: WANAKA 03 443 0024
E: services@qldc.govt.nz W: www.qldc.govt.nz
Page 2/11 // December 2020
Please add your site details - whether single or multi. Include all addresses where food is handled.
E.g. ABC Foods Limited E.g. Alphabet Café & Bar E.g. 123 Fake Road, Faketown 1234
REGISTERED COMPANY NAME
OR INDIVIDUAL DETAILS
TRADING NAME, IF ANY
(i.e. ‘Trading As’)
SITE DAY-TO-DAY
MANAGER POSITION
PHYSICAL ADDRESS
(For mobile companies state
address where based)
(Tick box if you
wish the address
to be withheld
from the public
register because
it is a private
dwellinghouse)
Name:
Name:
Name:
Name:
Name:
Position:
Position:
Position:
Position:
Position:
SITE INFORMATIONSECTION 3
Page 3/4 // June 2018
P: QUEENSTOWN 03 441 0499
P: WANAKA 03 443 0024
E: services@qldc.govt.nz W: www.qldc.govt.nz
Private Bag 50072, Queenstown 9348
10 Gorge Road, Queenstown 9300
47 Ardmore Street, Wanaka
Attached contract if QLDC is the nominated verier, or I have paid my $125 Registration Fee, or
Please invoice me the Registration Fee
1. I am authorised to make this application as the operator or a person with legal authority to act on behalf of the
operators listed in section 3
2.
The information supplied in this application is truthful and accurate to the best of my knowledge and belief; and
3. Every operator of the food businesses covered by the National Programme is resident in New Zealand within the
meaning of section YD 1 or YD 2 (excluding section YD 2(2)) of the Income Tax Act 2007
4.
Every operator of the food businesses covered by the National Programme is able to comply with the
requirements of the Food Act 2014
5.
I have read and I agree to the Food Business verication terms and conditions
I conrm that:
APPLICANT STATEMENT
FINAL CHECK AND DOCUMENT PACKAGE TO SEND TO COUNCIL
COLLECTION OF INFORMATION
SECTION 4
SECTION 5
SECTION 6
Complete for all applications. We accept PDF or scanned versions of signatures.
Have you:
COLLECTION OF PERSONAL INFORMATION
Pursuant to Principle 3 of the Privacy Act 1993, we advise that:
• This information is being collected for the purpose of registering under the Food Act 2014; and
• The recipient of this information, which is the agency that will collect and hold the information, is QLDC; and
• Some of the information collected will be displayed on a public register; and
• The collection of information is authorised under sections 79 and 83 of the Food Act 2014. The provision of this
information is necessary in order to process an application for registration under section 53; and
• The supply of this information is voluntary; however, failure to provide the requested information is likely to result in a
return of this application form, and may ultimately result in a refusal to register, in accordance with sections 84, 85, 86 and
87 of the Food Act 2014; and
• Under Principles 6 and 7 of the Privacy Act 1993, you have the right of access to, and correction of, any personal
information that you have provided.
COLLECTION OF OFFICIAL INFORMATION
All information provided to QLDC is ofcial information and may be subject to a request made under the Ofcial Information
Act 1982.
If a request is made under that Act for information you have provided in this application, QLDC must consider any such
request in accordance with its obligations under the Ofcial Information Act 1982 and any other applicable legislation.
NAME:
SIGNATURE:
JOB TITLE:
DATE:
Filled all required form elds in completely and legibly
Attached letter from your verication agency if not QLDC
Read and signed the Applicant Statement
Attached Company Registration certicate if applicable Attached copies of site plans and internal layout
FEES SCHEDULE Queenstown Lakes District Council fee structure can be found HERE
Private Bag 50072, Queenstown 9348
10 Gorge Road, Queenstown 9300
47 Ardmore Street, Wanaka
P:
QUEENSTOWN 03 441 0499
P: WANAKA 03 443 0024
E: services@qldc.govt.nz W: www.qldc.govt.nz
Page 4/11 // December 2020
What does ‘Scope of Operations’ mean?
The term ‘Scope of Operations’ is used to describe the activities of your food business and also includes:
• the sector(s) a food business operates under the Food Act 2014,
• what products a food business makes and/or sells,
• how products are sourced and/or supplied,
• how products are processed, if applicable, and
• how products are sold.
SCOPE OF OPERATIONS
FOR NP1 BUSINESSES
Why do I need to complete a ‘Scope of
Operations’?
If you are operating a food business you need to tell your local council or Ministry for Primary Industries (MPI) exactly what
your business does.
What do I need to do?
Complete this form and submit it with your application for registration to your local council or MPI.
Private Bag 50072, Queenstown 9348
10 Gorge Road, Queenstown 9300
47 Ardmore Street, Wanaka
P:
QUEENSTOWN 03 441 0499
P: WANAKA 03 443 0024
E: services@qldc.govt.nz W: www.qldc.govt.nz
Page 5/11 // December 2020
HOW DO YOU SOURCE AND SUPPLY YOUR PRODUCTS/SERVICES?
Tick all the trading operations that your business is involved in.
Caterer
Provides food, supplies and services for a social
occasion or function or within an education or
other facility
TRADING OPERATIONSSECTION 7
Eat-in site
Examples: restaurant, café, residential care,
early childhood education (ECE) centres and
kōhanga reo
Export
Home delivery
Examples: pizza delivery, meals-on-wheels and
grocery delivery
Import
Either as a registered food importer or through
an agent who is a registered importer
Internet
Online selling of food products
Market
Example: stall at a farmers’ or other market
Mobile
Example: food truck
On-licence
Eat-in site that sells alcohol for consumption at
the same location
Retail
Examples: supermarket, dairy or other site
selling direct to the consumer
Storage provider
Examples: cold stores and warehouses
Takeaway
Ready-to-eat meals sold for immediate
consumption at another location
Transport provider
Ambient or temperature-controlled transport
Wholesale
Site selling to retailers
Private Bag 50072, Queenstown 9348
10 Gorge Road, Queenstown 9300
47 Ardmore Street, Wanaka
P:
QUEENSTOWN 03 441 0499
P: WANAKA 03 443 0024
E: services@qldc.govt.nz W: www.qldc.govt.nz
Page 6/11 // December 2020
Tick all the activities your business does, and the products you make and sell.
DO YOU?
Hot beverage
Examples: coffee, tea and cocoa
Packaged food (shelf-stable products)
In manufacturer’s packaging
SELL HOT BEVERAGES AND/OR SHELF-STABLE PRE-PACKED FOOD
Food which does not require chilling or freezing
10 20
35
Ice cream Iced confectionery
Examples: ice blocks, frozen yoghurt
SELL ICE CREAM AND ICED CONFECTIONERY?
In manufacturer’s packaging
10 20
36
ACTIVITIES AND PRODUCTSSECTION 8
Sugar
Raw, brown, white and caster sugar
Sugar products
Examples: Syrups (glucose), molasses,
golden syrup and treacle
MANUFACTURE / MAKE SUGAR OR RELATED PRODUCTS
10 20
14
Herbs and spices
Fresh herbs and spices, cut or planted
Mushrooms
Mushrooms and fungi
20 40
33
GROW AND/OR PACK FOOD?
Minimally processed fruits and vegetables
Minimal processing - is limited to rinsing,
trimming, shelling, waxing and packing.
Excludes sprouts and microgreens
Nuts, seeds and grains
10 30
Sprouts and microgreens
50
Bulk food
Bulk food in a container for transport
Frozen food
40 10
17
TRANSPORT AND DISTRIBUTE OR WAREHOUSE FOOD?
Chilled food
Hot food
20 50
Shelf-stable food
30
32_010
EXTRACT AND PACK HONEY?
Private Bag 50072, Queenstown 9348
10 Gorge Road, Queenstown 9300
47 Ardmore Street, Wanaka
P:
QUEENSTOWN 03 441 0499
P: WANAKA 03 443 0024
E: services@qldc.govt.nz W: www.qldc.govt.nz
Page 7/11 // December 2020
Private Bag 50072, Queenstown 9348
10 Gorge Road, Queenstown 9300
47 Ardmore Street, Wanaka
P:
QUEENSTOWN 03 441 0499
P: WANAKA 03 443 0024
E: services@qldc.govt.nz W: www.qldc.govt.nz
Page 8/11 // December 2020
Registration Authority
Choosing a Verier
Conicts of Interest
Template Food Control
Plans registered with MPI
All businesses subject to a National Programme (all levels) have the right to choose their own verier. A verier is the
agency or person who will come and assess your business in order to demonstrate compliance with the Food Act
2014 and Food Regulations 2015.
Your food business must be registered in order to legally operate. Most commonly, your registration authority will be
your local council if your business operates solely within one district.
If your business operates over different council districts or operates from multiple sites, the Ministry for Primary
Industries (MPI) may instead be your registration authority. Check with your local council or MPI if you are unsure
who your registration authority should be.
You have the choice of selecting which agency you want to undertake your verications. This may be your local
council should they hold recognition or an independent (third party) organisation. A list of all recognised agencies
can be found on MPI’s website:
www.foodsafety.govt.nz/registers-lists/food-act-2014-recognised-agencies/index.htm
If any staff or contractors of the Council have been involved in the design of the customer’s food site or procedures, it
cannot act as the customer’s verier. The Council aims to undertake the agreed services in an independent and impartial
manner at all times.
If you are operating a multi-site business using a template FCP, and have been required to register with MPI or another
authority because you also operate outside the QLDC area, you may still choose to use QLDC as your verier.
If you have registered a template FCP (whether modied or not) with MPI for a business required to operate a custom
FCP, QLDC is not able to offer verication of custom FCPs.
Once you have chosen your verier, you will need to inform your registration authority of your choice. Your verier may
ask you to complete an agreement to ofcially nominate them as your verier.
Should you have any questions about choosing a verier, please contact either Queenstown Lakes District
Council or MPI on 0800 00 83 33.
CHOOSING
A VERIFIER
Private Bag 50072, Queenstown 9348
10 Gorge Road, Queenstown 9300
47 Ardmore Street, Wanaka
P:
QUEENSTOWN 03 441 0499
P: WANAKA 03 443 0024
E: services@qldc.govt.nz W: www.qldc.govt.nz
Page 9/11 // December 2020
CUSTOMER DETAILS
SIGNATURES
QUEENSTOWN LAKES DISTRICT COUNCIL TO COMPLETE
SECTION 1
SECTION 3
SECTION 2
CUSTOMER NAME
CUSTOMER
NAME
QLDC
REPRESENTATIVE
DESIGNATION /
TITLE
QLDC REPRESENTATIVE
DESIGNATION / TITLE
DATE
DATE
REFERENCE NUMBER
DATE OF START
OF CONTRACT
DATE OF TERMINATION
CONTRACT
POSTAL ADDRESS
PHYSICAL ADDRESS
CONTACT PHONE NUMBER
CONTACT PERSON AND TITLE
TRADING NAME
SIGNATURE
SIGNATURE
VERIFICATION
RISK CATEGORY
EMAIL
Verication Agreement
Customer Agreement
The parties agree that Queenstown Lakes District Council will verify the Template Food Control Plan or National
Programme level 1, 2 or 3 (as applicable) on the attached Standard Terms as set out in schedule 1 of this Agreement.
NOTE: This Agreement must be completed by a person who has the authority to act on behalf of the business e.g. the owner, operator or
director, partner or other person with legal authority to act on behalf of the registered company or partnership or individual(s).
The parties conrm that they have read and agree to the standard terms and conditions of this
Agreement (attached at Schedule 1):
[ if different ]
[ print name ]
[ print name ]
[ if different ]
[ e.g. Director, Manager ]
Private Bag 50072, Queenstown 9348
10 Gorge Road, Queenstown 9300
47 Ardmore Street, Wanaka
P:
QUEENSTOWN 03 441 0499
P: WANAKA 03 443 0024
E: services@qldc.govt.nz W: www.qldc.govt.nz
Page 10/11 // December 2020
Schedule 1: Food Business
verication terms and conditions
Queenstown Lakes District Council (“Council”) is a registration authority under the Food Act 2014 (“the Act”) for food control
plans (“the Plans”) and food businesses subject to a national programme (“the Programme”).
Under the Act, any appropriately recognised agency or person can verify a business operating under the Programme.
The Ministry for Primary Industries (“the Ministry”) has appointed Council a verier under the Act to verify businesses subject to
the Plans and the Programme.
The following terms and conditions apply to food businesses which have agreed for Council to act as their verier.
Terms used in these terms and conditions that are dened in the Act, have the meaning given to them in the Act.
1. TERM AND TERMINATION
1.1 Subject to the other provisions of these terms, the parties obligations to each other start on the start date and end on
the termination date set out in the verication agreement.
Assess each contract against available veriers and technical requirements, the contract will be declined if no verier
is available.
1.2
The customer may terminate the agreement with Council at any time by giving 1 month written notice.
1.3 If the customer’s registration is revoked, surrendered or substituted, or if the customer does not pay the Council’s
charges or meet any other responsibilities, Council may immediately suspend or restrict the services at any time.
Such activities will be reported to the registration authority (if not Council and/or the Ministry).
1.4
If the customer’s registration is revoked, surrendered or substituted, or if the customer does not pay the Council’s
charges or meet any other responsibilities, the Council may immediately stop providing any of its services to the
customer.
(a)
This right is additional to any other right or remedy the Council may have against the customer at law which
rights and remedies survive termination of this agreement.
1.5
Otherwise, where the Council has agreed to provide a service for a minimum period, it will continue providing it until
the end of that period, and will notify the customer, at least 14 days before it stops providing the service.
2. VERIFICATION
2.1 The customer agrees and acknowledges that:
2.1.1 The Council will carry out the verication function under the Act and the Food Regulations 2015 (“the
Regulations”), with respect to the customer’s food business.
2.1.2
The Council will obtain all evidence which in its discretion it requires to determine whether or not a food
business complies with the Programme and with the relevant provisions of the Act and Regulations.
2.1.3
The nature and extent of the Council’s procedures and processes may vary according to the type of business,
risk assessment, and previous compliance history and the Council will focus on what is most important for the
food safety at each type of business.
2.1.4
At the end of the verication, Council will provide the food business with an outcome report for the verication
detailing whether the verication is acceptable or unacceptable.
2.2
If any issues are discovered, Council will agree with the food business on a plan to address those issues, including
setting timeframes, and the timing of the next verication visit.
2.3
Council will provide the Ministry with a report of the outcome of the verication visit.
3 STANDARD OF SERVICE
The Council will use its best endeavors to:
>
Provide the services with care and skill
>
Ensure the verier is knowledgeable and competent to verify the customer’s specic food business operations. This
may include contracting a Technical Expert to assist in the verication of the customers food business
>
Provide the verication services within a reasonable time or within any agreed time limit
>
Provide the outcome Report under clause 2.1.4 within 10 working days of completing the verication
Private Bag 50072, Queenstown 9348
10 Gorge Road, Queenstown 9300
47 Ardmore Street, Wanaka
P:
QUEENSTOWN 03 441 0499
P: WANAKA 03 443 0024
E: services@qldc.govt.nz W: www.qldc.govt.nz
Page 11/11 // December 2020
4 CONFIDENTIALITY
The Council acknowledges that information held by the Council and the customer with respect to the verication of the
customer’s food site may be commercially sensitive to the customer. To the full extent permitted by law, and subject to
the Council’s obligation to comply with the provisions of the Local Government Ofcial Information and Meetings Act
1987, the Council agrees to keep all such information and communications condential.
5 COMPLAINTS AND DISPUTES
If the customer has a complaint in relation to the Council’s verication services or the person conducting them or
the customer disputes any recommendation put forward by the verier, please contact The Regulatory Manager of
Environmental Health. The Council documents all complaints in an attempt to improve its service under its Quality
Management System. All complaints are held as strictly condential. The customer may seek reconsideration of a
verication decision by applying to the Council in writing within 15 working days after receipt of the verication report.
6 CUSTOMERS RESPONSIBILITIES
6.1 The customer must advise the Council of any change of verier. This agreement can then be terminated with 1
month notice in writing to Council.
6.2
It remains the responsibility of the customer at all times to provide safe and suitable food. The verier does not
accept liability for food safety or for any losses incurred by the customer.
6.3
The customer agrees to provide Council with the following:
(a) reasonable access to the food business; and
(b) reasonable access to information and documents relating to the food business;
6.4 The customer warrants that all information and documents provided are, or will be, complete, true and accurate and
up-to-date at the time they are provided and that:
(a)
all food preparation tasks are being properly carried out by appropriate staff who have been suitably trained and
instructed; and
(b)
any restrictions or conditions place on the registration are being complied with; and
(c) they will notify Council of any further information, including any post verication events, which may have a
bearing on the verication.
7 OUR CHARGES
7.1 Verication fees are prescribed within Queenstown Lakes District Council’s fees and charges structure and are
subject to annual review and public notication through the Annual Plan process. The Council will provide the
customer with an invoice that must be paid by the 20th of the following month. Where follow up visits are required
additional fees as included in the fee structure may be incurred. Failure to attend a scheduled verication without
cancellation may also result in a charge.
Queenstown Lakes District Council fee structure can be found HERE
7.2
The Council will send invoices and other notices via email. It is the customer’s responsibility to advise Council of any
change of email address.
8 CHANGING THESE TERMS
Any changes to the terms of this agreement must be in writing.
9 DISCLAIMER
9.1 A verication under the Act does not constitute a permit, authorisation, or other permission under any other act,
regulation or bylaw. The verication report provided is based on the inspection of the accessible aspects of the
food business and represents the Council ofcer’s opinion of the observable condition of the building, facilities,
equipment and documents on the day and time of the inspection.
9.2
The verication report is prepared for the food business and the Ministry only. The food business agrees to not
disclose the verication report to any third party. The food business agrees to indemnify, defend and hold the
Council harmless from any third party claims arising out of the food business distribution of the inspection report to
any third party.
9.3
The Council’s liability for mistakes or omissions in the verication report is limited to a refund of the fee paid for the
verication.
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