Please mark one of the following:(Required) If you marked the second box, you may be required to register with the Council.
New Proprietor Details Note: If the proprietor is a company or association, specify name of person completing the application form and authority (eg. Director of Company).
Proprietor name(Required)
First
Last
Proprietor postal address
New Premises Details Street address of premises
Postal address of premises
Contact name(Required)
First
Last
(if not proprietor)
Vehicle garaged address At what address is the vehicle garaged when not in use?
Are you a community group that sells food up to two consecutive days at a time and most food handlers are volunteers? If NO, go to FOOD RELATED DETAILS section
Are you selling ready to eat high risk food? If NO, you are classified as Class 3. Go to CLASSIFICATION section.
Is all of the high risk food cooked on site with the intention of serving immediately? If YES, you are classified as Class 3. Go to CLASSIFCATION section.
If NO, you are classified as Class 2, however, you are exempt from the Food Safety Supervisor
requirements. Go to CLASSIFICATION section.
Are you a wholesaler / distributer of pre-packaged food? If YES, you are classified as Class 3. Go to CLASSIFICATION section.
If NO, proceed to question 2.
If YES, is this the only food handling activity at your premises? Is the food prepared or served exclusively for people or patients in an aged care service, hospital or meals on wheels service? If YES, you are classified as a Class 1. Go to CLASSIFICATION section.
If NO, proceed to question 3.
Is the food prepared or served exclusively for children at a childcare centre? If NO, proceed to question 4
Is the food high risk? If YES, you are classified as Class 1. Go to CLASSIFICATION section.
If NO, proceed to question 5.
Are you a greengrocer that only sells fruit, vegetables and / or packaged food? If NO, proceed to question 5.
Do you prepare fruit salad, fruit juice or salads? If YES, you are classified as Class 2. Go to CLASSIFICATION section.
Do you cut / slice fruits and vegetables? If YES, you are classified as Class 3. Go to CLASSIFCATION section.
If NO, you do not require a Food Act registration and are only required to complete the
notification form.
If none of the above applies to your premises, the classification of your premises will depend upon the risk associated with your food handling activities such as refrigeration and cooking. Please answer the following questions to assist the Council in determining whether your premises is a Class 2 or 3.
Do you handle food that does not require refrigeration? Is any of the food pre-packaged? Is any of the food being prepared / made and sold directly to the public? Is any of the food being manufactured on the premises to be sold at retail shops / wholesale / distributor? Is any of the food being re-packaged? Do you refrigerate, cook and / or reheat any food? Is any of the food pre-packaged? Is any of the food unpackaged? Is any of the food being prepared and sold directly to the public? Is any of the food being manufactured and sold to retail shops / wholesale / distributor?
Classification Following discussion with the Council about your food handling activities, select your food premises classification below as advised by your Council: Do you have a Standard Food Safety Program? If NO, proceed to question 2.
Please select the type of FSP and then proceed to FOOD SAFETY SUPERVISOR section Do you have a Non Standard Food Safety Program (Independent FSP)? If NO, specify when the premises is to be audited:
Has the program been audited by an approved Food Safety Auditor?
Declared QA Food Safety Program Has the FSP been prepared under a QA system or code declared under the Food Act? If NO, proceed to FOOD SAFETY SUPERVISOR section.
Audit certificate attached If YES, attach the certificate from the Food Safety Auditor confirming that the program has been prepared
under and conforms with that QA system or code.
Does the FSP include competency based or accredited training for staff of the premises? If YES, you are exempt from the Food Safety Supervisor requirement.
Documents Required for Quality Assurance and Audited Premises
Food Safety Program – Class1 and 2 Only Does your commercial business have a nominated Food Safety Supervisor?
Declaration of New Proprietor Class 3 food premises only In addition to the above and by ticking this box, I acknowledge that I will ensure that the appropriate minimum records required under the Food Act for the premises will be kept.
If the business is owned by a sole trader or a partnership, the proprietor(s) must sign and print name(s).
If the business is owned by a company or association, the applicant on behalf of that body must sign and print their name.
Signatory name
First
Last
Partner name
First
Last
Note: If the proprietor is a company or association, specify name of person completing the application form and authority (eg. Director of Company).
Postal address
Consent from previous proprietor to transfer the proprietorship from the previous proprietor to the new proprietor listed on the start of this form.
Name
First
Last
Name
First
Last
CONTACT US
Phone 03 5760 2600 to make an EFTPOS
or credit payment over the phone.
EMAIL council@benalla.vic.gov.au
IN PERSON
Visit the Council’s Customer Service Centre
at 1 Bridge Street East, Benalla
MAIL
Send this application back to us with a
cheque for the full amount made payable
to Benalla Rural City Council,
PO BOX 227, BENALLA VIC 3671