Yes Have you attached plans of the temporary premises? No Yes (please attach to this application). FOOD SAFETY SUPERVISOR (FSS) Do you have a FSS to nominate for this Food Business? Have you ever had a licence under the Food Act 2006, Tick ONE. the Food Act 1981 or a corresponding law that was suspended or cancelled? No (The FSS is unknown at this time). Tick ONE. If yes provide details about the licence, when it Note: This will not affect the decision made on your was cancelled or suspended and the reasons why. application. However you are required to provide the details No of your food safety supervisor(s) within thirty (30) days of Yes your licence taking effect. Yes (Please provide details below). Note: If you have additional Food Safety Supervisor(s) to add please attached the details to the application form. Have you been convicted of any offence under food Mr Mrs Miss Ms legislation in another state or country? Last/Family name Tick ONE. If yes provide details. No Yes First/Given name(s) Address of FSS Have you owned or operated a business with activities similar to that for which you are making this Tick ONE. If yes application? include details about size, location and nature of the operation. No Yes (Provide details) Contact details of FSS Phone: Mobile: Email: Do any of your previous roles, responsibilities and education provide you with knowledge that may be Tick ONE relevant to your application? If yes provide FOOD BUSINESS DETAILS details. What is the trading name of the food business? No What is the primary location where the food business will be carried out? If more than one location, provide details as an attachment. NOTE: For mobile premises, you need to provide an address PREMISES SUITABILITY where the mobile premises can be inspected within Toowoomba Regional Council Area. Fixed/mobile premises Premises suitability will be considered during this application as part of the For temporary premises, you need to provide details of any assessment. proposed locations of the premises to be used for this Temporary premises Plans of the site layout will be purpose. For example: Queens Park or for multiple locations: Queens Park, Laurel Bank Park, XYZ markets etc. required to be submitted
Yes Have you ever had a licence under the Food Act 2006, the Food Act 1981 or a corresponding law that was suspended or cancelled? Tick ONE. If yes provide details about the licence, when it was cancelled or suspended and the reasons why. No Yes Have you been convicted of any offence under food legislation in another state or country? Tick ONE. If yes provide details. No Yes Have you owned or operated a business with activities similar to that for which you are making this application? Tick ONE. If yes include details about size, location and nature of the operation. No Yes (Provide details) Do any of your previous roles, responsibilities and education provide you with knowledge that may be relevant to your application? Tick ONE If yes provide details. No PREMISES SUITABILITY Fixed/mobile premises Premises suitability will be considered during this application as part of the assessment. Temporary premises Plans of the site layout will be required to be submitted Have you attached plans of the temporary premises? No Yes (please attach to this application). FOOD SAFETY SUPERVISOR (FSS) Do you have a FSS to nominate for this Food Business? Tick ONE. No (The FSS is unknown at this time). Note: This will not affect the decision made on your application. However you are required to provide the details of your food safety supervisor(s) within thirty (30) days of your licence taking effect. Yes (Please provide details below). Note: If you have additional Food Safety Supervisor(s) to add please attached the details to the application form. Mr Mrs Miss Ms Last/Family name First/Given name(s) Address of FSS Contact details of FSS Phone: Mobile: Email: FOOD BUSINESS DETAILS What is the trading name of the food business? What is the primary location where the food business will be carried out? If more than one location, provide details as an attachment. NOTE: For mobile premises, you need to provide an address where the mobile premises can be inspected within Toowoomba Regional Council Area. For temporary premises, you need to provide details of any proposed locations of the premises to be used for this purpose. For example: Queens Park or for multiple locations: Queens Park, Laurel Bank Park, XYZ markets etc.
DOCS-%236951207-v2-EHS-Application_for_operational_food_licence.docx