Temporary Food / Market Stall Notification Form

Business/Licensee Details

ABN *

Lookup

ACN

ABN Status

ABN Status Effective From

Company Name

Trading Name *

Email Address *

Business Phone *

Mobile *

Registered Office Address *

Postcode *

Preferred Contact

Other *

Family Name *

Given Name *

Email Address *

Address *

Postcode *

Mobile *

Phone *

Market Details

Market Location *

Hornsby Mall Markets (Thursday) or Hornsby Twilight Markets (Saturday)Other

Are you requesting an ongoing stall? *

YesNo

Start Date *

Date of Market *

Information on trading at Hornsby Mall Markets and Hornsby Twilight Markets can be found at Hornsby Mall | Hornsby Shire Council and Markets | Hornsby Shire Council. Email permission can be sought by contacting the organisers at HornsbyTownCentre@hornsby.nsw.gov.au and office@organicfoodmarkets.com.au.

Attach permission from the organiser *

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Location of Market *

Date of Market *

Trading Details

Type of food to be sold *

Address of any additional food storage/preparation locations

Food Safety Supervisor

Family Name *

Given Name *

FSS Certificate Number *

Required Documents

Food Safety Supervisor Certificate *

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Stall Plan *

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Recent inspection report from your ‘home’ Council

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Checklist

As a stall holder, please confirm you will have the following required items onsite when you trade.

I will have a Food Safety Supervisor certificate onsite *

I will have a digital probe thermometer onsite *

I will have hand washing facilities onsite, including warm water, hand soap and paper towel *

I will have washing up facilities onsite to clean food contact utensils (additional to hand washing facilities) *

I will have a commercial food grade chemical sanitiser onsite *

I will have adequate hot and cold stage facilities onsite, e.g. ice esky or heat box *

I will have suitable tent construction, including smooth and washable floor covering (e.g. tarp or rubber mats), an enclosed ceiling, and all three sides of the stall enclosed with a smooth and washable material *

I will provide adequate measures to protect food from contamination, e.g. lidded containers and sneeze barriers *

I will have adequate shelving onsite to ensure food is not stored on the ground *

I will have adequate wastewater disposal containers onsite and ensure wastewater is removed from the site and disposed of in the sewer *

I will have adequate garbage bins with secure fitting lids onsite and ensure all waste generated onsite is removed and disposed of appropriately *

Declaration

Preferred Document Delivery Method *

EmailPost

I certify that the details I have provided are true and accurate. I undertake to keep Hornsby Shire Council informed of any changes. *

As the licensee, I declare that I will comply with the Food Act 2003 and Food Standards Code 3.2.2, 3.2.2A and 3.2.3. *

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