Food Act 2008- Notification/Registration Form

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Introduction
Proprietor/Business Details
Use of Premises
Conditions
Premise Details
Description of premises
Declaration
Office Use Only
Submit Response

Introduction

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Proprietor/Business Details

Proprietor Name*

Postal Address

Street Address:*

City:*

State:*

Post Code:*

Country:*

Phone Number*

ABN*

Email Address*

Hours of Operation*

# of full-time staff*

Use of Premises

Please indicate the intended Use of the Premises

Conditions

• A detailed plan of the layout of the establishment including details of the location of fixtures such as handwash basins, materials used for flooring and walls and details of waste disposal is to be submitted.

• Compliance with the Health (Skin Penetration Procedure) Regulations 1998 and the Code of Practice for Skin Penetration Procedures and Hairdressing Establishment Regulations 1972 where relevant.

• It is recommended that applicants hold appropriate qualifications.

• Applicant to refer to the WA Department of Health website which refers to various documents relating to cleaning, disinfection and the draft Public health guideline for the hairdressing and barber industry. Personal appearance (health.wa.gov.au)

• An Environmental Health Officer will need to conduct final inspection of the establishment. Please contact the Shire of Capel to make an appointment at your convenience. Business is not to commence prior to final approval.

Amount to be Paid: $90.00

Applicant Name

Signature*

Date*

Premise Details

Trading Name

Business Trading Address

Street Address:*

City:*

State:

Post Code:

Country:

Address where vehicle garaged (If Different)

Street Address:

City:

State:

Post Code:

Country:

Phone Number

Email Address

Name of person in charge and title

Details of food vehicle (make, model, registration plate)

Description of premises

Declaration

I, the person making this application declare that the information in this application is true and correct in every particular.

Signature of Applicant

Date

Office Use Only

Date Received:
Accepting Officer:
Amount to be Paid:
Receipt #
Premises Code #

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New Application for Food Business Registration	$130.40
Change of Ownership from a previously registered Food Business	$130.40
Food Business Notification (this fee applies to businesses that are exempt from registration under the Food Act 2008)	$ 39.35

Inspection Fee – Low Risk	$102.45
Inspection Fee - Medium Risk	$204.95
Inspection Fee - High Risk	$318.25