Environmental Health Unit

Telephone:(08)84080400

Facsimile:(08)8389 7440

Email:

FOODBUSINESSNOTIFICATION/UPDATE FORM

ThisFoodBusinessNotificationformis designedforasinglebusinesslocation. Whereafoodbusinesssellsfoodfrom multiplelocationsa separateformmustbecompletedforeach location.

Informationtoassistyoutocompletethefoodbusinessownershipandbusinesslocationdetailscanbefoundfollowingeach table.

Shouldyouhave anyquestions,concernsorrequireclarificationonany aspectofthis formpleasecontacttheAdelaideHills

CouncilEnvironmentalHealth Unitonthedetailsgivenabove.

Notforprofitorganisationsholdingonlyoccasionaleventssuchassausagesizzles,Devonshireteas orbakesalesshouldfill outtheTemporaryFoodStallNotificationFormavailableby contactingthe EnvironmentalHealthunitoronlineat

Oncefullycompleted,this formmustbe submittedinpersonorbymail(ensuringsuitabletime toallowfordeliveryand assessment)toAdelaideHillsCouncilatoneof thefollowingaddresses/councilcentres.

WoodsideServiceCentre

POBox44

28MainStreet,Woodside SA5244

OpenforCouncil business

MondaytoFriday8:30am to5:00pm

StirlingServiceCentre

63MountBarker Road,Stirling SA5152

OpenforCouncil business

MondaytoFriday8:30am to5:00pm

Part1-FoodBusinessOwnershipDetails

Name(s)ofthe Proprietor(s):

ACN(AustralianCompanyNumber)

MailingAddress

PostaladdressLine1

Line2

Suburb/TownPostcode

ContactBusinessTelephone

MobilePhone

Faxnumber

Email

(Inthecaseof multiplebusinessownerspleaseattach additionalsheetsandindicatewhoistoact astheprimarycontact)

NotesoncompletingtheFoodBusinessOwnershipDetails

Proprietorname:Mandatoryentry

ACN:TheAustralianCompanyNumber(ACN)appliestoCompaniesregisteredwiththeAustralianSecuritiesandInvestmentsCommission (ASIC). TheACNismandatoryifyourbusinessisacompany. AcompanycanbeaProprietaryLimited(PtyLtd)UnlimitedProprietary(Pty) Limited(Ltd)orNoLiability(NL)

Mailing address:Mandatoryentry.Allwrittencommunicationswiththe proprietorofafoodbusinesswillbesenttothisaddress.

Businesstelephone:Mandatoryentry.Allphonecommunicationswiththeproprietorofafoodbusinesswillbetothis number.Amobile,faxor emailcontactisoptional.

Part2-BusinessInformation

ABN
RegisteredBusinessName
Commontradingnameofbusiness
StreetaddressLine(NotaPObox)
Line2
Suburb/Town: / Post Code
Streetaddressforthe businesspremiselocation
Wherea mobilefood vendingbusinessispermanentlystationed
forbusiness
Wherethe mobilefood vending/transportvehicleisnormally
garaged)
Addresstype
Tickoneboxonly
NumberofFullTimeEmployeeshandlingfood
Numberof fulltimeequivalentemployeeshandlingfood
(example:Twofulltimeemployeesplus threeemployeesworkinghalftimewouldequal
3.5full timeequivalentemployees)
Date commenced
Preferred business email address
Pleaseprovideashortdescriptionofthebusinessanditsoperation

NotesoncompletingBusinesslocationinformation

Theaddressinformationinthis sectionrelatestoinformationaboutthebusinesslocation. Thismaybe differenttothebusinessowner address information.

ABN:Optional entryifthebusinessisnotrequiredtohaveanABN.Allbusinesseswithanannualturnover of $50000ornon-profit organisationswithanannualturnoverof$100000requireanABN.Organisationswitha lowerannualturnover maychoosetoregisterforan ABN.ContacttheAustralianTaxationofficefor informationonapplyingforanABN.Phone 13 2861.

Registeredbusinessname: Mandatoryentryifyoutradeother thanunder yourownpersonal name.Ifthefoodbusinesshas beenregistered underthe NationalCorporationsAct 2001administeredby theAustralianSecurities InvestmentsCommission(ASIC),thenthe registered companynameshouldbeenteredhere.Ifthefoodbusinesshas beenregisteredunderstateorterritorylegislationandnot under the National CorporationsAct2001,thenthatregisteredbusinessnameshouldbe enteredhere. Ifyouare unsureifyouarelegallyrequiredtohavea registeredbusinessnamecontacttheOfficeofConsumerandBusinessAffairson

(08)82049779

Commontradingname:Requiredifthebusinessdoesnot havea registeredbusinessname.Ifabusinessnameisnot registered,indicatethe nameunderwhichthe businessisknownoroperates.

Businesslocationaddress:Mandatoryentry.Thebusinesslocationaddressmustbeastreetaddressnot apostofficeboxorsimilarpostal address

Addresstype: Mandatoryentry.Abusinesswillselect one ofthe3options.Astreetaddressindicatesabusinesssuchasa retailshop,factory, foodtransportdepotorsimilarpermanentpremises.Twooptionsare providedformobilefoodvending/transportvehicles. Formobile vehiclesstationedatapermanentlocationsuchasapiecartoperatingfroma leasedsiteselectthesecondoption.Abusinessoperatinga mobilevehiclesuchas anice-creamvanorafoodtransportvehicledeliveringfoodwouldtickthethirdoptiontoshowtheaddresswherethe vehicleisnormallygaraged.

Numbersof employeesandnumberoffulltimeequivalent(FTE)employees:Mandatoryentries.Includeonlythoseemployeeshandlingfood.

Datecommenced:Mandatoryentry.The datewhen youtookownershipofthefoodbusiness.Ifan exactdateisnot knownprovidetheyear.

Preferredbusinessemail address:Mandatoryentry,Thismaybethesameastheemailaddressgiveninpart1andwillbe usedby councilto distribute educationalmaterials. ThisaddresswillNOTbe passedontosalesagents orsimilar.

GeneralBusinessOperatingTimes
Sun / Thurs
Mon / Fri
Tues / Sat
Wed

Part3-FoodBusinessSectorInformation

Thefollowingfoodbusinesssectorquestionsare mandatory. Businesseswillbe categorisedunder threesectors- manufacturing,retailfood serviceanddistribution. It ispossible forabusinessto selectmorethanone sector. Forexamplea largebakerymanufacturingproductsprimarilyforwholesalemay alsohavearetailoutleton the samesite. Inthiscaseboththe manufacturingsectorandretailandfood servicesectorwouldbe selected. Alternativelyabakerypredominatelyoperatingas a retailershouldtickthe retailandfood servicesectornot the manufacturingsector.

Pleasetickoneormoreof theappropriatebox(s)below to indicatethe sectororsectorsin whichyour businessoperates.Then gotothepageindicatedtocompletequestionsforeachsectorticked.

 / Manufacturing Sector
This Page below /  / Retail and Food Service Sector
Page 4 /  / Distribution Sector
Page 5

Part4– ManufacturingSector (Seenotesbelow)

(a)Please tick the types of food manufactured by your business (May be more than one)
 / Dairy products /  / Raw fish, shellfish and seafood
 / Rawmeatandpoultry /  / Processed fish, shellfish and seafood
 / Processedmeatandpoultry /  / Soft drinks /non-alcoholic drinks /juices
 / Cooked& uncookedfermentedmeatproducts /  / Egg or egg products
 / Edibleoilsandoilproducts /  / Sugar products, confectionery including chocolate products or honey
 / Rawfruitand/orvegetables /  / Infant or baby foods
 / Processedfruitand/orvegetables /  / Alcoholic drinks
 / Cerealandflourproducts /  / Ice and water including spring water
 / Bakery goods, bread, pastries, cakes /  / OTHER including mixed foods (specify below
If OTHER please specify business type: ______
______
(b) / Does your business only manufacture low risk foods /  Yes /  No
(c) / Do all foods manufactured by your business have a Pathogen Reduction step? /  Yes /  No
(d) / Does your business manufacture uncooked fermented comminuted meat products?
(salami and similar uncooked meat products) /  Yes /  No

Notesonthe ManufacturingSector

Thisfoodsectorissubdividedintobroadcategoriesbasedonthetypeoffoodproduced.Thereisan optionforOTHERtocoverafoodtypethat doesnot fitintoone ofthe definedfoodcategories.Afoodbusinessmaychoosemorethan one categoryoffood.

Lowriskfoodisafoodthatisunlikelytocontainpathogenic(potentiallyharmful)microorganismsandwillnot normallysupporttheirgrowth duetofoodcharacteristics.Examplesaregrainsandcereals,bread,carbonatedbeverages,sugar-basedconfectionery,alcoholandfatsand oils.

Apathogenreductionstep isaprocessingstepthatsignificantlyreducesthe microbialpopulationpresentinafoodmaterial.Examplesare cooking,pasteurisation,canningorfermentationoranyotherprocessingstepthatiscapableofsignificantlyreducingthelevelofpathogenic organismpresent.

Uncookedfermentedcomminutedmeatproducts. Thesearemanufacturedand processedmeatproductssuchassalamiandmettwurstthat donotincludecookinginthe processofmanufacture.

Part5–Retail andFoodServiceSector

(a) / What best describes your food business type? TICK ONLY ONE BOX that represents the predominant description of the business
 / Bakery /  / Mobile food vending vehicle
 / Butcher /  / Restaurant
 / Chemist/Pharmacies /  / Service station
 / Café /  / Snack Bar / Kiosk
 / Canteen /  / Club including sport club
 / Caterer /  / Supermarket
 / Child care centre /  / Takeaway food business
 / Delicatessen /  / Temporary food business
 / Farm gate sales /  / Charitable / fund raising / Community Organisation
 / Fishmonger / Seafood / Businesses service at risk persons:
 / Fruiterer / Green grocer /  / Aged Care facility (e.g. hostel, nursing home)
 / Function centre /  / Hospital
 / Guesthouse / Bed & Breakfast / Motel /  / Home delivered meals to the elderly
 / Hotel / Pub / Tavern / None of the above
 / Liquor store /  / OTHER including specialty shop
 / Stall / If OTHER or speciality food shop please specify business type below:
If OTHER please specify business type: ______
______
(b) / Does your business only sell low risk foods (packaged and unpackaged) or medium risk foods received and sold in the manufacturer’s / supplier’s original sealed packaging. /  Yes /  No

Notesonthe RetailFoodServiceSector

Theretailandfood servicesectorisbasedonthetypeofbusinessdescription.Withinthis groupisasubgroupdefinedasbusinessesservingat riskpersons.Thesebusinesseswillbeclassifiedashighpriority.ThecategoryOTHERisalsoincludedforbusinessesnotcoveredinthe provided options.

Lowriskfoodisafoodthatisunlikelytocontainpathogenic(potentiallyharmful)micro-organismsandwillnot normallysupporttheirgrowth duetofoodcharacteristics.Examplesaregrainsandcereals,bread,carbonatedbeverages,sugar-basedconfectionery,alcoholandfatsand oils. Fortheretailandfoodservicesectorlowriskfoodalsoincludeswholefruitandvegetables.

Mediumriskfoodisafoodthatmaycontainpathogenic(potentiallyharmful)micro-organismsbut willnot normallysupporttheirgrowthdueto foodcharacteristics;orfoodthatisunlikelytocontainpathogenicmicro-organismsduetofoodtypeorprocessingbutmaysupportformation of toxins orgrowthofpathogenicmicro-organisms.Examplesarecut fruitandvegetables,orangejuice,canned meats,pasteurisedmilk,dairy products,icecream,peanutbutterand milk-basedconfectionery.

Part6–DistributionBusiness

(a) / What best describes your food distribution business type? TICK ONE BOX ONLY
 / Importer / None of the above
 / Food Transport /  / OTHER
 / Cold storage
 / Wholesale Distributor / Packer
 / Warehousing
If OTHER please specify business type below:
If OTHER please specify business type: ______
______
(b) / Does your business only sell low risk foods or (packaged and unpackaged) medium risk foods received and old in the manufacturer’s / supplier’s original sealed packaging /  Yes /  No
(c) / List the description and registration details of each transport vehicle used by the business.
______
______

Notesonthe FoodDistributionSector

Foodtransportincludesgeneralcarriersthattransportfood.Vehicledescriptionand detailsarerequiredashealthofficershavearesponsibility toinspectthesuitabilityoffoodtransportvehicles.Asuggestedformis(APY261; Isuzurefrigeratedvan)

Notificationsubmittedby:

Signed

ForOffice UseOnly

Notification receivedby:

DateNotification received://20

NotesonNotification

Ifyouchangethe nameoraddress ofthe business,you have14days inwhichtonotifyCouncilofthechanges.YoumustnotifyCouncilofanyotherchangestothenotificationinformation,priortothechangestaking place.Notethatthisisa legalrequirement.You mayalso dothis onlineusingyournotificationnumberandPIN.AlternativelyyoucancontactCouncildirectlyandanewnotificationformwillbeforwardedto you.

Shouldyourbusinessbetransferred,thenewproprietormustgivewritten notice(bycompletinganewnotificationformorsubmittingan online notification)within14days ofthe dateoftransfer.

Inthecaseofmultipleproprietors,thesignatureandinitialsofeachmustbe providedtocouncil.

Pleasenotethatcouncilofficerswillmakeeveryattempttoavoidinspectionsduringverybusyperiodshoweverthisisnotaalwayspossible. Section37oftheFoodAct2001provideofficerswiththeauthoritytoundertakeinspectionsat anyreasonabletime