Food Safety Supervisor Notification

Privacy

Privacy Collection Notice

This personal information in this form is collected by Toowoomba Regional Council for the purpose of assessing the request in this form and performing related functions. Council's privacy policy is available at tr.qld.gov.au/privacy.

Applicant type

Is this application for an individual or a company/organisation?

IndividualCompany/organisation

Applicant details

Title

First name(s)

Last name

Phone number

Company / Organisation details

If the licence is in a company name the application should be completed by a nominee for the licensee.

Company/organisation name

Contact person full name

Phone number

Trading details

Trading name

ABN

Licence details

Food licence number

Food licensee details

Current location of food business

Street address

Suburb

State

Postcode

Food Safety Supervisor Notification

Add/remove food safety supervisor

Would you like to add or remove a food safety supervisor?

AddRemove

Primary food safety supervisor details

Title *

First name(s) *

Last name *

Phone number

Postal address

Postal address *

Suburb *

State *

Postcode *

Additional food safety supervisors

Are there additional food safety supervisors?

YesNo

Additional food safety supervisor 1

Title *

First name(s) *

Last name *

Phone number

Food safety supervisor for removal

Title *

First name(s) *

Last name *

Phone number

Additional food safety supervisors for removal

Are there additional food safety supervisors for removal?

YesNo

Additional food safety supervisor 1

Title *

First name(s) *

Last name *

Phone number

Food Safety Supervisor Notification

Fees

There is no fee for this application.

Declaration

I confirm that I am the licensee or nominee for the licensee for the above food business and that I understand:

I must at all times continue to have a food safety supervisor for the food business under the licence.
I must ensure that a food safety supervisor for the food business is reasonably available to be contacted by the local government that issued the licence while the food business is being carried on.
I must ensure that the food safety supervisor for the food business is reasonable available to be contacted by persons who handle food in the food business while the food business is being carried on.
I must, within 14 days after a person stops being a food safety supervisor for the food business, advise the local government.
I must, within 14 days after the contact details of a food safety supervisor for the food business changes, advise the local government of the change.
The information provided in this application is true and complete to the best of my knowledge.
Council may refuse this application if it becomes evident that any information or supporting documents provided is incomplete or false.
I approve of the information that has been provided in this application.
I acknowledge Queensland State Laws will accept this communication as containing my signature within the meaning of the Electronic Transactions (Queensland) Act 2001.

Signature

I agree with the declaration *

Full name of applicant

Date

Form process

After you submit this form, a Council officer will contact you as your request is progressed. This usually occurs within three working days.

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