Home Based Food Business
Application Form
Applicant Name:
Applicant Address:
Phone Number:
Mobile:
Email Address:
Proposed Business Name:
Proposed Business Location:
Type of Business: Retail / Manufacturing / Storage or Distribution
Description of the type of food (i.e. caterer, sushi, cakes, hot meals, biscuits) and your intended market (eg.
who you plan to sell to).
Volume or Quantity Produced:
Weekly/Monthly.
Operating Details:
No. of days per week:
No. of Employees:
on Sun/Mon/Tue/Wed/Thurs/Fri/Sat
.
The business activities to be will be undertaken in:
- a separate kitchen/area
- your own domestic kitchen?
Please give details


.
.
Please attach with this form a basic layout of your kitchen, including the location of your proposed hand wash
basin.
APPLICANT SIGNATURE:
DATE:
.
Home Based Food Business
Application Form
Please draw basic layout of your kitchen including, fixtures and fittings such as sinks and storage space (drawing
is not required to be to scale), ensure you include location of proposed hand washing facilities.
OFFICE USE ONLY:
Assessed By:
Date:
Allocated Risk:
Inspection Frequency:
Comments:
.
.
.
.
Preliminary Inspection to be conducted on:
Hand Basin Exemption required?
Signed:
Yes
No
.