CYNGOR SIR CEREDIGION COUNTY COUNCIL
APPLICATION FOR THE REGISTRATION OF A
FOOD BUSINESS ESTABLISHMENT
This form should be completed by food business operators in respect of new food business establishments
and submitted to the relevant food authority 28 days before commencing food operations. In order to allow
us to appropriately risk assess your business and schedule the necessary inspection it would be
appreciated if you could complete all sections as fully as possible.
1. Name of food business
(trading name)
2.
Address of establishment (or
address at which moveable
establishment is kept)
Post Code:
Contact Details:
Telephone No
e-mail
website address
3. Full Name of Food Business
Operator
4. Address of Food Business Operator
Post Code:
Contact Details:
Telephone No
e-mail
5. Type of food business. Please tick ALL the boxes that apply:
Farm Shop
Staff restaurant/canteen/kitchen
Food/manufacturing/processing
Catering
Packer
Hospital/residential home/school
Importer
Hotel/pub/guest house
Wholesale/cash & carry
Private house used for a food business
Distribution/warehousing
Moveable establishment e.g. ice cream van
Retailer
Market Stall
Restaurant/café/snack bar
Food Broker
Market
Takeaway
Seasonal Slaughter
Other (please give details):
…………………
………………………………………...………………
Please provide a brief description of your business and the types of food you intend handling:
..….…
……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
November 2013
6. Type of business.
Sole Trader
Limited Company
Partnership
Other (please give details):
……...……....
………………………………………………………
7. Limited Company Name
Company No
Registered Office Address
Post Code:
8. Distribution and sale.
Please indicate the expected maximum number of customers supplied per day / event.
less than 20
0 – 200
Distributed locally
Distributed nationally
Please tick if you intend specifically supplying food to any of the following groups.
Under 5 years old
Over 65 years old
Immunocompromised
9. Equipment. Do you have any of the following equipment?
Refrigerators
Yes/No
Slicer
Yes/No
Freezers
Yes/No
Vac packer
Yes/No
Chilled display cabinet
Yes/No
Hot holding unit
Yes/No
10. Training. Please list any formal food hygiene training which you and/or your staff have undertaken.
Name
Training Course
Date undertaken
11. Food Safety Documentation. What documented food safety procedures do you have in place?
HACCP
Yes/No
Safer Food Better Business
Yes/No
Temperature monitoring
Yes/No
………………………………………………………………
Cleaning schedule
Yes/No
……………………………………………………………..
Other:
……………………………………………...
………………………………………………………………
November 2013
12. Number of vehicles or stalls kept at, or used from, the food business establishment and used
for the purposes of preparing, selling or transporting food:
5 or less
6-10
13. Water Supplied to the Food
Business Establishment
11-50
Public (Mains) Supply
51 plus
Private Supply (Well, spring, borehole)
14. Full Name of manager (if different from operator)
15. If this is a new business, date you intend to
open
16. If this is a seasonal business – period during
which you intend to be open each year
17. If this is a mobile business, please indicate
intended trading locations
18. Number of people engaged in food business count part-time worker(s) (25 hrs per week or less)
as one half
0-10
11-50
51 plus
Signature of Food Business Operator
Date
Name (BLOCK CAPITALS)
AFTER THIS FORM HAS BEEN SUBMITTED, FOOD BUSINESS OPERATORS MUST NOTIFY
ANY CHANGES TO THE ACTIVITIES STATED ABOVE TO CEREDIGION COUNTY COUNCIL
AND SHOULD DO SO WITHIN 28 DAYS OF THE CHANGE(S) HAPPENING.
The completed form should be sent to:
Food & Safety Section
Lifestyle Services
Neuadd Cyngor Ceredigion
Penmorfa
Aberaeron
SA46 0PA
OR
The preferred method of contact is by
email therefore please return to
[email protected] (form
also available electronically from this
address).
Tel: 01545 572105
e-mail: [email protected]
November 2013