Notification of a Class 4
Food Premises
Council Use Only
Application Number:-
Food Act 1984
Application Date:Officer Name:-
Tel: 03 9240 1111
http://www.moreland.vic.gov.au
Important- Fields marked with an asterisk (*) are mandatory and must be completed.
Class 4 premises information
Please note: this form is only applicable to Class 4 food premises. You will be considered a Class 4 premises if your
only proposed food handling activities are as follows:
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The sale of shelf stable pre-packaged low risk food such as confectionery, crisps, bottled drinks – for
example, newsagent, post office or pharmacy.
The sale of packaged alcohol – for example, bottle shops.
The sale of uncut fruit and vegetables – for example, green grocers and wholesalers.
Wine tasting (which can include serving low risk food or cheese).
The sale of packaged cakes (excluding cream cakes).
The supply of low risk food, including cut fruit, at sessional kindergarten or child care.
Simple sausage sizzles at stalls, where the sausages are cooked and served immediately. This means
sausages, sauce, onions and bread. (This does not include hamburgers or other high risk foods).
If your proposed food handling activities are anything other than what is described above, you will need to register
your premises using the ‘application to register a food premises’ form.
For more information about food premises classification, please contact Council or visit the following website:
http://www.health.vic.gov.au/foodsafety/bus/class.htm
If your proposed Class 4 food business is a temporary / mobile food premises such as a sausage sizzle stall or a wine
tasting marquee at an event, you will need to notify Council via the ‘Streatrader’ website instead:
https://streatrader.health.vic.gov.au/public_site
Tick this box to acknowledge your only food handling activities are Class 4 activities*
Premises details
If the food premises is a mobile vehicle, the premises address is the location where the vehicle will be kept overnight.
Trading name of premises*
Street Address *
Suburb*
State*
Postcode *
Brief description of the premises’ proposed use including food to be prepared/ stored*
Number of staff working at the premises*
Full Time
Part Time
Casual
Vehicle details (mobile food premises only*)
Make:
D15/184026
Model:
Registration No:
Colour:
Amended October 2015
Proprietor details
Title*
Given Name(s) *
Surname*
Company Name
ABN/ACN
Street Address/ Postal Address*
Business Phone*
(
Suburb*
Mobile*
State*
Postcode*
State
Postcode
Email
)
Contact for this application (if different from proprietor)
Title
Given Name(s)
Surname
Company Name
ABN/ACN
Street Address/ Postal Address
Business Phone
(
Suburb
Mobile
Email
)
Declaration
The information on this form is used to process the application only. Visit Council’s website to view our privacy policy.
I understand and acknowledge that:
- The information provided in this application is true and complete to the best of my knowledge
- This application forms a legal document and penalties exist for providing false or misleading information
Name of 1st proprietor/ applicant*
Signature of proprietor/ applicant*
Date *
Name of 2nd proprietor/ applicant*
Signature of proprietor/ applicant*
Date *
\
Fees & lodgement
There is no fee associated with notification of a Class 4 food premises.
You can submit this application in person, by post, fax or email:
Moreland City Council
Municipal Offices: 90 Bell Street, Coburg VIC 3058
Postal Address: Locked Bag 10, Moreland VIC 3058
Telephone: 03 9240 1111
Fax: 03 9240 1212
Email: [email protected]
Website: http://www.moreland.vic.gov.au/
D15/184026
Amended October 2015