Fillable New fixed food business licence Postal Address Development (Department of the Environment and Energy)

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New fixed food business licence Postal Address Development (Department of the Environment and Energy)

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Development Services Page 1 of 4 July 2021
Postal Address Development Services Internet
PO Box 159 Ph: 07 3205 0555 www.moretonbay.qld.gov.au
Caboolture QLD 4510 mbrc@moretonbay.qld.gov.au
Fees listed are applicable 1 July 2021 – 30 June 2022 ABN: 92 967 232 136
Applicants must complete the sections specified and provide a floor plan as outlined in Section H.
Applicant type and fees:
New fixed food business licence
Application fee - $573.00
Complete Sections A to I inclusive
Please note: A pro-rata licence fee will also apply to this application. You will be notified of the fee once the licence has been
assessed. The licence fee must be paid prior to the issue of the licence and commencement of trading
.
Existing licence – Structural changes to existing premises
Application fee - $573.00
Complete sections A, B, H and I
Existing food business licence number:
Briefly describe the proposed changes:
Section A - Licensee details
If applicant is an individual - complete Section A1
If applicant is a company - complete Section A2
If applicant is an Incorporated Association - complete Section A2
If applicant is an agent or consultant for the licensee - complete Section A3 (and A1 or A2 if licensee is known)
Section A1.- Individual application
.
First name:
Surname:
Address (not a PO Box):
ABN (if applicable):
Postal address:
Email address:
Home number:
Mobile phone:
Work phone:
Section A2. - Company or Incorporated Association application
A business name, trust, shop name, partnership or unincorporated company is not considered a legal entity.
Legal name:
Name of directors/or members of management committee:
(The names of all directors or members of management committee must be listed - attach a list if more names apply).
ABN:
ACN:
Email address:
A
ddress (not a PO Box):
Companies
- registered address
Incorporated Associations
- nominated address
as registered with ASIC
Postal address:
Contact person name:
Business number:
Mobile phone: Work phone:
Food business licence application –
New fixed premises
Page 2 of 4
Section A3. - Agent or consultant of licensee
Name of business
Contact person name:
Postal address:
Business number:
Mobile phone: Work phone:
Email address:
Section B – Details and location food business
Food business trading name:
Street address where the food business will be located:
Shop number and shopping centre name (if applicable):
Real property description:
Lot:
Plan:
What is the expected commencement date to start trading?
Section C – Description of the food business activities
(Attach a copy of the menu or a list of proposed foods):
Identify each of the following categories that apply to this application:
Accommodation meals Dry bakery patisserie Food shop
Beverage manufacturer Café/restaurant Hospital meals
Care facility meals Caterer - off site Fruit & veg processing
Caterer - on site Child care centre meals Home kitchen
Delicatessen Food manufacturer/packer
Takeaway
Other - please specify below
Section D – Suitability of person to hold a licence
What skills and knowledge regarding the sale of safe and suitable food does the applicant possess? (attach copy of
certificates or other supporting documentation):
Have any of the applicants been convicted for a breach of any food legislation?
No Yes – If yes, please attach details.
Have any of the applicants previously held a licence under the Food Act 2006, Food Act 1981 or a corresponding law that
was suspended or cancelled?
No Yes – If yes, please attach details.
Have any of the applicants previously been refused a licence under the Food Act 2006, the Food Act 1981 or a
corresponding law?
No Yes – If yes, please attach details.
Note: If the applicant is a corporation or an incorporated association, this also applies to an executive officer of the corporation or a
member of the association’s management committee.
Page 3 of 4
Section E – Nomination of Food Safety Supervisor
The food act requires all food businesses to have a suitably qualified food safety supervisor. Council will require evidence of
the qualifications for your nominated food safety supervisor. Complete the section below and attach details of qualifications
that correlate with those approved by Queensland Health for Food Safety Supervisors
.
Full name:
Postal address:
Business Phone No:
Email address:
Have qualifications been attained?
Yes – please attach a copy of the certificate of attainment.
No – A copy of the certificate of attainment must be forwarded to council within 30 days of issue of the licence.
Section F – Other requirements
Does a valid Development Permit under the planning scheme exist for this activity?
Yes – Provide permit number below:
Not required (the activity is accepted development in this zone)
No / Don’t know – Do not submit this application. You will need to determine the suitability of this site with regard to
zoning of the land.
This application is processed under the Food Act 2006 however the proposed development may have obligations under
other legislation that directly impact on this application. List other current approvals or applications applicable for this
development
:
Approval type Permit number (or state if applications have been lodged)
Building
Plumbing
Trade waste (Unity
Water)
Other – Please specify
Section G – Food safety programs
It is the applicant’s responsibility to identify whether the activity is required to have an accredited Food Safety Program as
per the Food Act 2006. If a food safety program is required, this application for a Food Business Licence can not
be processed unless it is accompanied by an Application for Accreditation of a Food Safety Program.
Application for accreditation of a food safety program attached (Form is available on Council’s website):
Yes
Not required
No – Do not submit application until one is available
Page 4 of 4
Section H – Application checklist
Complete the following checklist and ensure required documentation is attached. Failure to provide required information
will result in delays to the processing of the application.
Site plan showing the location of the food premises, waste storage, car parking, staff and public toilet facilities and
adjacent land uses
Floor plan with dimensions showing, but not limited to, the following –
• Location of all equipment, fixtures and fittings
• Hand wash basins
• Food preparation sink
• Double bowl sink
• Cleaners sink
• Hot water system
• Dry food storage areas
• Refrigeration and freezer units
• Mechanical ventilation above cooking appliances
• Office area for administration work
• Storage area for cleaning products
• Storage area for staff personal items
• Internal refuse storage
• Toilets
Sectional elevations with dimensions indicating windows, doorways, items identified on the site plan and details of
plinths, castors or legs of all benches
Hydraulic plan showing location of water and sewerage pipes, tundishes, sinks and grease trap
Specifications of materials and finishes (including colours where appropriate) for ceilings, walls, floors, coving,
doors, lighting, shelving, cupboards, benches, screens, air curtains and insect control devices
Section I – Applicants summary
I hereby certify that I have completed all required sections of the application form, attached all supporting information, i.e.:
plans and elevations and have paid the applicable fee as nominated on this form.
Disclaimer: Should approval be given to this application such approval will not extend to approving any other statutory or
Local Government requirements relating to this premises
.
Advice should be sought from a building certifier and/or plumber for any building or plumbing works.
Applicants Signature:
Date:
Privacy statement
Moreton Bay Regional Council is collecting your personal information for the purpose of assessing your application for a food
business licence. The collection of this information is authorised under the Food Act 2006. Council will use your personal information
to update council’s customer information records and to contact you about other functions and services of council.
Office use only
Receipt number: __________________________________ Amount: ___________________ Date: ______________________
CSO: ______________________________________ Application number: ___________________________________________
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New fixed food business licence Postal Address Development (Department of the Environment and Energy)

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Completed 1 June 2022

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