Street Number Street Name Suburb/Town What is the nature of the food business? For example: Washing, preparation, packaging and Postcode distribution of ready to eat salads. Preparation, cooking to order and table service of Thai style cuisine. Lot/Plan(s) (if known) Home business producing and bottling of jams and chutneys for commercial sale. Delivering potable water for human consumption. Phone no. Mobile no. Email address. What is the intended commencement date to start Preferred Contact Person trade? / / Which of the following categories of Food Businesses apply to this application? What are the expected hours of operation? Child Care Centre Processing food for delivery to vulnerable persons Food Manufacturer Sale of meals at least 12 times each financial year by non-profit organisation Off-Site Caterer SECTION 3 DECLARATION – On-Site Caterer Note: Providing false or misleading information in this Private Hospital application may lead to legal action or prosecution. Sale of unpackaged food by retail I declare that: - Please specify ______________________ I am the applicant or an authorised signatory for the NOTE: Off-site catering, on-site catering and food provided applicant. to vulnerable persons (child care centres, aged care The information provided is true and correct to the best facilities and food providers and delivery meal of my knowledge. I understand that it is offence under organisations) require a Food Safety Program. Section 268 of the Food Act 2006 to provide Toowoomba Regional Council (TRC) or an authorised Provide details regarding the nature of the catering person, documentation containing information that I operation. know is false, misleading or incomplete. NOTE: Also attach details of all mobile food vehicles I understand that all information provided with this involved in the catering operation. application form may result in the application being refused. I understand that all information supplied on or with this application form may be disclosed publicly in
Street Number Street Name Suburb/Town Postcode Lot/Plan(s) (if known) Phone no. Mobile no. Email address. Preferred Contact Person Which of the following categories of Food Businesses apply to this application? Child Care Centre Processing food for delivery to vulnerable persons Food Manufacturer Sale of meals at least 12 times each financial year by non-profit organisation Off-Site Caterer On-Site Caterer Private Hospital Sale of unpackaged food by retail - Please specify ______________________ NOTE: Off-site catering, on-site catering and food provided to vulnerable persons (child care centres, aged care facilities and food providers and delivery meal organisations) require a Food Safety Program. Provide details regarding the nature of the catering operation. NOTE: Also attach details of all mobile food vehicles involved in the catering operation. What is the nature of the food business? For example: Washing, preparation, packaging and distribution of ready to eat salads. Preparation, cooking to order and table service of Thai style cuisine. Home business producing and bottling of jams and chutneys for commercial sale. Delivering potable water for human consumption. What is the intended commencement date to start trade? / / What are the expected hours of operation? SECTION 3 – DECLARATION Note: Providing false or misleading information in this application may lead to legal action or prosecution. I declare that: I am the applicant or an authorised signatory for the applicant. The information provided is true and correct to the best of my knowledge. I understand that it is offence under Section 268 of the Food Act 2006 to provide Toowoomba Regional Council (TRC) or an authorised person, documentation containing information that I know is false, misleading or incomplete. I understand that all information provided with this application form may result in the application being refused. I understand that all information supplied on or with this application form may be disclosed publicly in
DOCS-%236951207-v2-EHS-Application_for_operational_food_licence.docx