Fixed Food Premises Application Form

Fixed Food Premises 
Application Form

All retail food businesses must use this form to notify Council before they begin to trade.  

Approval from Council may also be required for any of the following reasons:
Starting a new food business 
Carrying out construction works or modifications in an existing food premises 
Fitting out a new food premises

Please visit ballina.nsw.gov.au/starting-a-new-food-business for more information.
This application is for
Select...
This question is required
Applicant Name
This question is required
Business/Trading  Name
This question is required
Entity that operates the business
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This question is required
ABN
This question is required
Street Address of Business
Street*
City/Suburb
State*
Zip/Post Code*
Country*
This question is required
Residential Address
if different from above
Street
City/Suburb
State
Zip/Post Code
Country
if different from above
Postal Address
Street*
City/Suburb
State*
Zip/Post Code*
Country*
This question is required
Business Phone Number
Mobile Phone Number
This question is required
Email Address
Please enter a valid email
Type of Food Business
Please refer to Council's Fees and Charges for annual fees that apply to each Food Business type
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This question is required
Please refer to Council's Fees and Charges for annual fees that apply to each Food Business type
Description of your proposed business
This question is required

Do you require a Food Safety Supervisor Certificate?
The Food Safety Supervisor (FSS) requirements apply to businesses that process or sell food at the retail level, that is:
a) ready-to-eat
b) potentially hazardous (requires temperature control)
c) not sold and served in the suppliers packaging.

If you meet all three of these requirements, then you need to appoint an FSS. For more information regarding Food Safety Supervisors or approved training organisations please visit www.foodauthority.nsw.gov.au
Yes
No
The Food Safety Supervisor (FSS) requirements apply to businesses that process or sell food at the retail level, that is:
a) ready-to-eat
b) potentially hazardous (requires temperature control)
c) not sold and served in the suppliers packaging.

If you meet all three of these requirements, then you need to appoint an FSS. For more information regarding Food Safety Supervisors or approved training organisations please visit www.foodauthority.nsw.gov.au

Is this application connected to a Development Application (DA) or Home Based Business request?
Yes
No
Applicant declaration
I apply for approval to undertake the activity described in this application and declare that all the information in the application is, to the best of my knowledge, complete and accurate.

I acknowledge that if the information provided is misleading any approval granted ‘may be void’ and accept that Council cannot be held liable for delays in processing arising out of inadequacies in the material submitted in support of this application.

I understand that approval of this application is not guaranteed.

I acknowledge that I am responsible for advising Council of any business changes including, but not limited to contact details or mailing address.

I acknowledge that the premises and operation of the business must be in compliance with the Food Act 2003, Food Standards Code, and associated legislation.

I acknowledge and understand that it is my responsibility to advise Council (in writing) if at any time I cease business operations.
I agree with the above declaration
Yes
No
Signed
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Full Name
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SUBMIT

Privacy Protection Notice
The completed Food Premises application form contains personal information that is being collected for the purpose of assessing this application. The information will be processed by the Planning and Environmental Health Division of Ballina Shire Council and may be made available to public enquiries under the Government Information (Public Access) Act. The information will be stored in Council’s electronic document management system. For further information please visit ballina.nsw.gov.au/your-privacy.