11-71-T36

Temporary Event Food Notification Form - Individual Food Outlet

This form should be submitted at least one (1) weeks prior to the activity / event

This notification is for a food outlet that operates, or intends to operate:

More frequently than once every 3 months - E.g regular markets / fundraising stalls etc. Less frequently than once every 3 months - E.g annual or occasional events / fundraising stalls etc.

No further notification required unless business details have changed.

Notification required for each occasion.

Event Details

Name of Event *

Start Date of Event

End Date of Event

Location of Event

Food Business Proprietor (person(s) or Company 'Pty Ltd') *

ABNAustralian Business Number

FBN *Food Business Notification Number

To obtain your FBN number, complete and submit the SA Health Food Business Notification form on Council's website at http://www.portlincoln.sa.gov.au/foodsafety

TrusteeIf applicable

Trustee ABN

Business Trading Name *

Business Address *

Street address *

City *

State *

Postcode *

Postal AddressIf different to Business Address

Vehicle Registration If a Food Vehicle / Trailer

Contact Name *

Position / Title *

Business Phone *

Mobile *

Email

Registered Charity / not for profit organisation? *

YesNo

Food Stall / Vehicle Details

Please Provide a short description of the business and the food being sold *Attach a copy of menu if available

Upload Menu

Browse

If you selected 'other' please specify

Where will you prepare the food sold at the stall? *

At the food stall / vehicleAt an approved food premisesAll food is pre-packaged, no preparation required

Please Note- All food prepared off-site must be prepared in an approved food premises.

Name of Food Business

Address

FBN

Food Safety

Have you or your staff completed Food Safety Training?

YesNo

If you have not yet completed any training you may complete the free DoFoodSafely course available online at https://dofoodsafely.health.vic.gov.au/index.php/en/

Food Safety SupervisorIf required

Expiry date

Food Safety Supervisor required when potentially hazardous food that is unpackaged is handled. Exemptions apply for one-off fundraising events run by a charity / not for profit organisation.

Stall Setup

Please complete the attached checklist and return it with this form.

Temporary Food Stall Checklist

This checklist id designed as a guidance tool to ensure temporary food business operations achieve minimum requirements base on the Food Safety Standard 3.2.2, Food Safety Standard 3.2.2A, and Food Safety Standard 3.2.3. It does not limit your legal responsibilities and obligations under the SA Food Safety Legislation.

Refer also to SafeWork SA requirements for food actering sites at http://www.safework.sa.gov.au or call 1300 365 255, and any additional requirements set by the event organiser and / or approval authority.

Complete ALL sections below

Notification

The food business has been notified and the food business number is provided on the application form. *

YesNoN/A

Food Saftey Standard 3.2.2A requirements (if required)

Food safety supervisor available when potentioally hazardous unpackaged food handled *

YesNoN/A

Exemptions apply for one-off fundraising events run by a charity

All other food handlers have training required under Standard 3.2.2A *

YesNoN/A

Records being kept under Standard 3.2.2A *

YesNoN/A

General - Note: Whenever LPG cylinders and cooking equipment are used, 3 sided stalls may not be required to allow for adequate ventilations, however, adequate steps to protect food, packaging and equipment from contamination must be in place)

Preparation and service area to be enclosed is adequately screened *

YesNoN/A

The stall consists of a roof and at least three (3) sides and is suitable for the purpose *

YesNoN/A

If on unsealed ground, the floor covering is of an impervious materail that is free from open joints, cracks and crevices e.g vinyl cut larger than the floor area *

YesNoN/A

Food Storage

All food is stored at least 150mm above teh ground and is protected against all likely sources of contamination

YesNoN/A

All raw food is stored separately from ready-to-eat food

YesNoN/A

All food is covered

YesNoN/A

Equipment storage

All condiments are contained in squeeze-type containers, dispensers or individually sealed packs

YesNoN/A

All eating utensils, e.g spoons, straws, paper cups, are enclosed in suitable containers or otherwise protected from contamination

YesNoN/A

Food on display

Food on display is protected from all likely sources of contamination. Sneeze barriers provided

YesNoN/A

Labelling - Note: Some exemtions apply for charity / fundrasing events

Labelling of packaged foods complied with Chapter 1 of the Food Standards Code, where required

YesNoN/A

Thermometer

The food business has a probe accurate to + / - 1 deg Celsius. It is also recommended that temperature checks are carried ot and documents on a temperature record sheet

YesNoN/A

The probe thermometer is cleaned and sanitised between uses

YesNoN/A

Single-use items

All single-use items are protected from contamination

YesNoN/A

Contact with food

Food handlers avoid unnecessary contact with food, e.g tongs and gloves are used where possible. Hand washing is performed before handling any ready-to-eat food. It is recommended that separate staff handle money.

YesNoN/A

Sanitising

Cooking, eating and drinking utensils are cleaned and sanitised before each use

YesNoN/A

Food contact surfaces of benches and equipment are cleaned and sanitised before use

YesNoN/A

Details of sanitiser products are available and all bottles and equipments are appropriately labelled. Sanitisers are used in accordance with the manufacturer's directions

YesNoN/A

Hand Washing facilities

A minimum 10L container of fresh warm potable with a suitable tap provided for hand washing and additional water available if required

YesNoN/A

Liquid soap and disposable paper towels are maintained at the hand wash facility

YesNoN/A

A suitable labelled container is provided for collecting all wastewater

YesNoN/A

Food preparation

A separate food preparation sink is required for onsite food preparation e.g washing fruit or vegetables

YesNoN/A

Food preparation benches and utensil washing

A minimum 10L (with a tap) of fresh potable water is available for utensil washing and additional water available if required

YesNoN/A

A suitably labelled container for collecting wastewater is provided (or other approved method)

YesNoN/A

If appropriate washing up facilities are not available onsite, enough clean serving utensils and cutlery are available in clean, labelled and lidded containers

YesNoN/A

A separate lidded and labelled container is available to store dirty utensils and cutlery for cleaning and sanitising off-site at the end of trade

YesNoN/A

Food temperature control

Food prepared at the stall is for immediate consumption only

YesNoN/A

Potentially hazardous food, that is stored or on display, is under the following temperature control. Cold food at or below 5 deg Celsius and hot food at or above 60 deg Celsius.

YesNoN/A

Potentially hazardous foods that have been out of temperature control for 4 hours are discarded (records kept and can be provided for upon request)

YesNoN/A

Cooking

All heating and cooking equipment is located within food stall or otherwise suitably protected from contamination and public areas

YesNoN/A

All food waiting to be cooked is stored within the food stall or cool room

YesNoN/A

The cooking area is kept free from contamination

YesNoN/A

Cooked food is kept separate from any contaminated utensils and containers

YesNoN/A

The walls of the stall are protected from heat, flame and hot liquid splashing

YesNoN/A

Waste Disposal

Suitable waste containers are provided

YesNoN/A

Waste products disposed of lawfully e.g waste water disposed of to sewer

YesNoN/A

Waste oil is stored and disposed of correctly

YesNoN/A

Declaration

I, *Print Name

The person making this application declare that:

The information contained in this applcation is true and correct;

I will notify the City of Port Lincoln's Environment & Regulatory services Department of any variation to details provided within this application prior to trading or changes during the trading period;

I agree to comply with the requirements of the SA Food Safety Legislation and the National Food Standards Code.

I declare that all the information I have supplied is true and correct. I acknowledge that personal information provided may be used by the City of Port Lincoln for the purpose of Council business, as specified in Council's Privacy Policy.

*

Signature *

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Date of Signature *

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