INTENTION TO CONDUCT A TEMPORARY FOOD PREMISES

To be submitted with a Special Event Permit or Stall Holder Permit where food is to be sold. To be received by Council a minimum of 7 days prior to the Event. (Mid Murray Council, PO Box 28, Mannum SA 5238).

NOTE: Information on the Food Act 2001 and the Food Safety Standards is available on the website – and or email enquiries to . or contact the Environmental Health Officer at Mid Murray Council on 85646020 during office hours.

Name of Operator: …...... ……………………………………………………………

Postal Address of Operator: …...... ………………………..…………………………………

Telephone Number of Operator: …...... ……………………………………………………

Trading As: ...... ………………………………………………………………………………

Business Address: ...... ………………………………………………………………………

  1. Type of Operation (circle):

* Stall* Mobile Unit / Van

* Tent / Marquee* Stand

* Hall* Other (please specify)

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  1. Event:

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  1. Location of Temporary Food Premises (Describe as accurately as possible):

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  1. Date and Time the Temporary Food Premises will operate:

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  1. Please specify the full range of food stuffs offered (or supply menu):

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and circle any of the following items you will sell, either directly or as ingredients:

* Milk / Milk Products* Cream

* Salads* Rice Dishes

* Poultry* Small Goods / Meat Products

* Egg Products* Meat (Raw)

* Meat (Cooked)* Fish / Fish Products

* Ice Cream* Sandwiches

* Shellfish* Other (list)

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  1. How will you ensure proper temperature control and protection from contamination during food preparation, transport, storage and display?

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  1. How will food be transported to the Temporary Food Premises?

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  1. What facilities will be available for people handling food to wash their hands?

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  1. How will the wastewater be disposed of?

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  1. Will the food be prepared at the Temporary Food Premises or another location? You must provide records upon request (owner, address) of any other location i.e. registered food premises, home kitchen etc.

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  1. Is the Operator’s food business registered in accordance with the Food Act (2001) with the Mid Murray Council? (circle)

YesNo

If “No” is the Operator’s food business registered with another Council? (circle)

YesNo

If “Yes” provide the Council’s name: …………...... ………..……………………….

And provide the Food Business Notification Number: ….…………………………

If “No” a completed Food Business Notification Form must be attached.

DECLARATION:

I ………………………………………...... …..(print name), will take all practical measures to ensure food sold during the permit period is fit for human consumption and not contaminated.

I understand my obligations under the Food Act 2001 and the Food Safety Standards.

Signed:……………………………….……………....…………………………………

On Behalf of:………………………………….....……………………………………………

Date:…………………………………….

Received by the Mid Murray Council Environmental Health Officer:

Name:……………………………………….....………………………………………………

Date:……………………………………

Office Use:
Temporary Food Premises: Approved Not Approved
Signed: …………………………………….....………… Date: …....………………………..

Environmental Health Officer

Mid Murray Council Temporary Food Premises Permit – Page 1