Temporary Food Stall Application

Applicant name (Full name and title)*

Name of Organisation*

Address*

Postal Address*

Mobile/Phone Number*

Fax

Email*

Name of Event/Activity*

Dates of Event/Activity*

Is this a seasonal application? (Seasonal applications must be more than 2 days and a maximum of 6 months)

YesNo

Location of Event/Activity*

Proposed Operating Times*

Proposed area in m2 to be occupied (LG property only):*

Number of people working at the temporary food premise:*

Names and addresses of people assisting at the temporary food premise:*

Is this stall or van registered?*

YesNo

Name of local authority stall or van is registered with:

Where is food being prepared/cooked?*

At the eventAt HomeAt a Registered Food Business

Address of off site preparation:

If preparing food at home please tick the category that best describes you activities

Prepare and provide food as part of a bed and breakfastPrepare food as part of a tourPrepare cakes, biscuits, or other flour products that do not contain creamPrepare and provide food as part of a family day carePrepare and provide food as part of a community/charitable fundraiserCake decorating
JamsPickled onionsChutneys, relishes and saucesRepackaging confectionery productsOther

If other please specify

If Registered Food Business please provide current Certificate of Food Business Registration

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Stall Structure*

Marquee (enclosed on 3 sides)Trestle table (open at sides)Food Van

Describe layout. include hand washing, servery & cooking equipment & benches:*

Stall Structure Diagram

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Please provide detailed description of food and drink sold:*

Describe how food will be stored and how temperature will be monitored:*

If transporting food items, how will they be transported to the site?

CarVanRefrigerated VanOther

If other please specify

Approximate Travel Time:

Please describe how food items will be displayed:*

Have you had a food stall before?*

YesNo

Have you completed I'm Alert or Food Safe Online food safety training?*

YesNo

The permit holder must have Public Liability insurance (minimum cover $20,000,000) relating to the approved activity. A copy of the Public Liability Insurance certificate must be attached with this application.

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Declaration:*

I declare that I am the person named as applicant on the above form and that the information contained in this application is true and correct in every particular.

Date:*

Welcome to the Shire of Exmouth

General Office:

Address