Temporary Food / Market Stall Notification Form

Business/Licensee Details

Company Name *

Trading Name *

ABN *

Email Address *

Business Phone *

Mobile *

Postal Address *

Postcode *

Preferred Contact

Title *

MrMrsMsMissOther

Other

Family Name *

Given Name *

Company/Organisation (If applicable) *

Email *

Address *

Postcode *

Mobile *

Phone *

Market Details

Location of Market

Suburb

Postcode

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 *

Browse

Stall Plan *

Browse

Recent inspection report from your “home Council” *

Browse

Checklist

As a stall holder please complete the following checklist:

Food safety supervisor certificate held onsite.

YesNo

A digital probe thermometer held onsite.

YesNo

Hand washing facilities provided. Warm water, hand soap and paper towel are required.

YesNo

Washing up facilities to clean food contact utensils are required (additional to hand wash facilities).

YesNo

A commercial food grade chemical sanitiser held onsite.

YesNo

Provide adequate hot and cold storage facilities e.g. ice esky or heat box.

YesNo

Suitable tent construction: Smooth and washable floor covering e.g. tarp or rubber maps, all three sides of the stall are enclosed with a smooth and washable material, and an enclosed ceiling.

YesNo

Provide adequate measures to protect food from contamination e.g. lidded containers and sneeze barriers.

YesNo

Adequate shelving to ensure food is not stored on the ground.

YesNo

Adequate wastewater disposal containers are provided. Ensure waste water is removed from site and disposed of in the sewer.

YesNo

Adequate garbage bins with secure fitting lids are provided. Ensure all waste generated onsite is removed and disposed of appropriately.

YesNo

Authorisation

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

Name *

Date *

Signature *

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