PO Box 103
Glenorchy Tas 7010
Ph: (03) 6216 6800
gccmail@gcc.tas.gov.au
ABN: 197 5325 2493
Licence Number:
Temporary Food Application
Please Tick ()
 Application for Registration of Food Business (Food Act 2003, Sections 86 & 87)
(Relates to the handling or sale of potentially hazardous foods such as milk, eggs, meat (i.e. BBQ), and sandwiches)
*PLEASE NOTE: PAYMENT MUST ACCOMPANY APPLICATION*
Applicant Details (Organisation/Business/Vendor)
Name of Applicant: ..............................................................................................................................................
ACN (if a Company): .................................................................................................................................................
Address: ...............................................................................................................................................................
..............................................................................................................................
Postcode: .........................
Telephone: .................................................................
Mobile Phone: ............................................................
Facsimile: ...................................................................
Email: ..........................................................................
Operator Details
Name of proposed operator (must be person): ..................................................................................................
Address of proposed operator (residential address): .........................................................................................
..............................................................................................................................
Telephone: .................................................................
Postcode: .........................
Mobile Phone: ............................................................
Details of food safety qualifications, training or experience of the applicant or food handlers (if any). Please
attach details if insufficient space. ...............................................................................................................................
..............................................................................................................................................................................
..............................................................................................................................................................................
Premises Details
Location of premises (stall, market etc): ............................................................................................................
Trade name of premises (stall/business name): .................................................................................................
Emergency contact ............................................................. Telephone ...........................................................
For Mobile Food Business- vehicle registration number and address where garaged: ......................................
..............................................................................................................................................................................
Proposed date/hours of operation (or attendance on site):
Mon ................................... Tue .................................. Wed ................................ Thu ..................................
Fri ....................................... Sat ................................... Sun ..................................
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Types of food – please tick the box:
 Prepared, ready-to-eat table meals
 Processed fruit and vegetables
 Frozen meals
 Raw fruit and vegetables
 Raw meat, poultry or seafood
 Infant or baby foods
 Processed meat, poultry or seafood
 Bread, pastries or cakes
 Fermented meat products
 Egg or egg products
 Meat pies, sausage rolls or hot dogs
 Dairy products
 Sandwiches or rolls
 Prepared salads
 Soft drinks/juices
 Other ______________________
 Confectionery
______________________________
Skills & Knowledge Questionnaire
Have you completed the attached questionnaire within last 6 months:
Yes / No
(please circle)
If yes, there is no requirement to complete again, otherwise continue overleaf.
Payment
Payment must accompany application. The current fee can be obtained by following this link
http://www.gcc.tas.gov.au/content/Schedule_of_Fees.GCC?ActiveID=1135
The completed application form, together with the payment, should be posted to Glenorchy City Council,
PO Box 103, Glenorchy, TAS, 7010. Payment may be made by: credit card (on last page of this document);
cheque (payable to Glenorchy City Council); or cash (in person at the Glenorchy City Council Customer
Service Centre, 374 Main Road Glenorchy). If the event is within 5 working days, please contact Council on
6216 6797 as you may be required to bring the application into Council’s Customer Service Centre.
Payment by Credit Card:
Payment can be made by inserting your credit card details on the final page of this document. Council
must not legally keep credit card details so pleased be advised that the details provided on the last page
will be destroyed once payment is processed.
Fee & Signature
Application fee: $ … ...................
Signature of applicant / operator: ....................................................................... Date: ................................
Payment by Credit Card (Please note payments made by credit card will attract a 1% surcharge)
Please indicate card type:
Card Number: .... .... .... ....
MASTERCARD

.... .... .... ....

VISA
.... .... .... ....
.... .... .... ....
Expiry Date: .................... / ..................
Amount: $ ........................................ (fee + 1%)
Signature: .............................................................
Name (as shown on card): ...................................................................................
Page 2 of 4
FOOD PREMISES OPERATOR SKILLS & KNOWLEDGE QUESTIONAIRE
Each statement must be answered
Please tick the correct answer
PERSONAL HYGIENE
1. Food handlers must wash his/her hands in an easily accessible hand wash basin with liquid soap, warm running
water, and dry hands with paper towel (select all that apply)
o Before handling food
o
o
o
After using the toilet
Before handling food contact surfaces
After having a break
2. To meet the requirements of the food standards code, food handlers must have access to:
o Running water for hand washing
o Soap
o paper towel
o tea towel
3. Do Hand sanitisers kill all germs and viruses?
o Yes
o No
4. All cuts, wounds and abrasions should be
o Left uncovered
o
Covered with a clean, brightly coloured bandaid
5. Gloves should be changed as often as I wash my hands
o Yes
o No
6.
Appropriate hair coverings should be worn when preparing uncovered food.
o True
o False
7. Food handlers must NOT go to work when suffering from symptoms of food poisoning. Symptoms include: (select
all that apply)
o
o
o
8.
Diarrhoea
Vomiting
Stomach pains
Food businesses are responsible for ensuring food handlers have appropriate skills and knowledge.
o
o
True
False
FOOD STORAGE
9. Cold food must be kept below 5°C
o True
o False
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10. Germs (bacteria) can double in numbers every 15-20 minutes in optimal conditions. Which following factors
contribute to these conditions? (select all that apply)
o
o
o
Food
Moisture
Warmth
11. Hot food must be kept above 60°C
o True
o False
12. Frozen food is best defrosted: (select all that apply)
o In the sink or hand basin
o On the bench
o In the fridge
o Microwave
13. The 4-hour/2-hour rule means ready-to-eat high risk foods that have been stored at ambient temperature (e.g.
not in refrigerator or heater) for a total of: (select all that apply)
o
o
o
Less than two hours must be refrigerated or used immediately.
Between 2 and 4 hours must be used immediately.
More than 4 hours must be thrown out.
CLEANING
14. A detergent is used to ______________ whilst a sanitiser used with sufficient contact time ________.
(Fill in the
blank spaces from the options below)
Kills germs
Loosens grease
Kills Viruses
15. Diluting a sanitiser outside of manufacturer’s specifications (higher concentration) is more effective
o True
o False
16. Before inserting a thermometer into foods it is important to wash the probe and clean it with a sterile wipe.
o
o
True
False
COMPLETED BY
NAME:
........................................................................
SIGNED:
............................................
DATE:
............................................
Office Use Only
Score
Pass /Fail
Approved/Refused
Signed ( CSO )
/ 16
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