Primary Produce (Food Safety Schemes Act 2004

PRIMARY PRODUCE (FOOD SAFETY SCHEMES) ACT 2004

APPLICATION FOR APPROVED AUDITOR

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This form is to be completed persons seeking to be approved as an auditor under the Primary Produce (Food Safety Schemes) Act 2004.

The completed application should be returned to the Administrative Officer, Food Safety Program, Biosecurity SA, GPO Box 1671, ADELAIDE SA 5001.

The application must be accompanied with the application fee of $171.

PERSONAL DETAILS

Name (First Name and Surname) :
Address for Correspondence:
Contact Phone Number:
Facsimile Number:
Mobile Number:
Email Address:

EMPLOYMENT DETAILS

Are you  Self employed  Subcontracting  Audit Company Employee

Company Name
Trading Name (if applicable)

AUDIT CERTIFICATION

Please indicate the current auditing certification(s) held with RABQSA.

Competency based

Qualification based

NFSA based

Grade:

Level:

Scope(s):

PERSONAL HISTORY INFORMATION

Have you been convicted of any criminal offence in the last five years in any state, territory or federal court? If yes, please provide details of the offence. /  Yes /  No
Do you agree to a criminal history check being completed via Australian Federal Police if required a later stage? /  Yes /  No
Have you previously been denied approval to undertake the role of a food safety auditor, or had an auditing accreditation or registration suspended or cancelled by any licensing authority in Australia in the last 12 months? If yes, attach a detailed explanation. /  Yes /  No

INSURANCE

Do you or your employer have insurance as detailed in the Deed?
Public and Products Liability Insurance for not less than $10 Million /  Yes
Professional Indemnity Insurance for not less than $2 Million /  Yes
Have enclosed copies of certificates of insurance /  Yes

DECLARATION

I, …………………………………………………………………………………………………………...

declare that the particulars set out in the application are true to the best of my knowledge and belief.

I agree to abide by the PIRSA Approved Auditors Code of Conduct (either ‘as attached’ or ‘dated’).

I understand the application fee is not refundable.

I understand I will enter into an agreement with the Minister that outlines the conditions of my approval as an auditor.

I understand if I am approved as an auditor I may be subject to a check audit by PIRSA on a random basis.

I understand my name, any conditions of approval and any other information required by PIRSA will be made available on a public register on the PIRSA Food Safety Program website.

Please sign the application in the box below. Date …………………………

(Your signature will be scanned and will appear on your ID card)

The completed application should be forwarded with the application fee of $171 (Contact the Administrative Officer on 08 8207 7964 for information on how to pay via EFT), a colour passport photo and copies of insurance to:

Administrative Officer

Food Safety Program

Primary Industries & Resources SA

GPO Box 1671

ADELAIDE SA 5001

______

If paying via credit card, please complete the following:

Cardholder’s name:______

Card Type: ⁫ Visa ⁫ Mastercard

Card Number: ______

Signature:______Expiry Date _ _/ _ _