Fillable amendment of a food safety program (Department of the Environment and Energy)

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amendment of a food safety program (Department of the Environment and Energy)

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Country of origin: AUSTRALIA
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Public Health Page 1 of 2 June 2021
P
ostal Address Customer Response Department 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
Applicant details:
If applicant is an individual - complete Section A If applicant is a company - complete Section B
If application is an Incorporated Association - complete Section B
Section A - Individual application
First n
ame:
Surname:
Address
(not a PO Box):
ABN (if applicable)
:
Postal address:
Email address:
Home number:
Mobile phone:
Section B - Company or Incorporated Association application
A business name, trust, shop name, partnership or unincorporated company is not considered a legal entity.
Legal name
:
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:
Email address:
Food business details:
Trading name:
Licencee name
:
Address of food premises:
Food business licence number:
Real property description
: Lot: Plan:
Application for accreditation or
amendment of a food safety program
Page 2 of 2
Premises details
(please tick the relevant box that identifies the primary use as per section 99 of the Act):
Off-site caterer.
On-site caterer (primary activity of the food business is on-site catering at the premises stated in the licence).
On-site caterer (primary activity of the food business is on-site catering at part of the premises stated in the licence
where 200 or more people are served on 12 or more occasions per year).
Private hospital caterer (part of the operations of a private hospital under the Private Health Facilities Act 1999).
Food service to vulnerable populations (handling potentially hazardous food or other food that is reasonably likely
to pose a risk to public health of safety. This includes aged care facilities and child care centres).
Voluntary submission.
Advice from food safety auditor:
Section 103(2) of the Food Act 2006 states that local government must receive and consider the written advice of an
auditor. The advice must state if the food safety program complies with the criteria in section 104 of the Act.
Please note that the processing of your application cannot proceed until written advice has been provided.
Is written advice from an auditor provided with this application Yes No - Do not submit until this is available
Supporting information and fees required to be submitted with this application:
Application for a new food safety program i.e. this food business has never had an accredited food safety
program previously.
Application fee:
New fixed premises $346.00
OR
Existing fixed premises, mobile, temporary food business $346.00
One electronic copy of the food safety program (Microsoft Word version preferred)
Written advice from an auditor
Amendment of a food safety program
i.e. changing a component of the food safety program e.g. changing
the way food is handled
Application fee of $230.00
One electronic copy of the food safety program
Written advice from an auditor
Provide details of how food handling has changed:
Customer summary:
I acknowledge the information provided in this application is, to my knowledge not false or misleading. I understand that
an annual fee is applicable to this licence.
Name of applicant (printed or typed):
Signature:
Date:
Office use only
CSO: ______________________________________ Application number: __________________________________
Receipt number: _________________________ Amount: ___________________ Date: _______________________
Privacy statement
Moreton Bay Regional Council is collecting your personal information for the purpose of assessing your application for accreditation or amendment of a
food safety program. 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.
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amendment of a food safety program (Department of the Environment and Energy)

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Completed 1 June 2022

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