ROADSIDE STALL APPLICATION FORM TEMPLATE

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Jacob Fowler
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1 ROADSIDE STALL APPLICATION FORM TEMPLATE Please note: The intention of this document is to provide a basic template as a starting point for council staff to develop an application form for people wanting to set up roadside food stalls. Content should be updated in line with internal council policies and procedures. To access the full resource kit please visit Contents Applicant checklist... 2 Part 1 Applicant details... 3 Part 2 Site details... 3 Safety and vandalism... 4 Location... 4 Size... 5 Part 3 Roadside stall details... 5 Part 4 Declaration... 7 Part 5 Lodgement details

2 Applicant checklist Before submitting this form, please ensure that you have read the Roadside Food Stall guidelines (Council to insert hyperlink to where guidelines can be found). The purpose of this form is to ensure that council has all the information required to assess your application as efficiently as possible. Please Note: a registration fee may be applicable with submission. Before you submit this form, ensure that you have filled in all sections of the form and attached: Attachment A A plan of layout and location of the roadside stall and associated infrastructure Appendix B A copy of your Certificate of Currency for Public Liability Cover of at least $10,000,000 2

3 Part 1 Applicant details Proposed Dates of roadside stall operation: First Day../../... Last Day../../. Roadside stall proprietors name Contact person name Postal address P.O. Box or Street address: Suburb/Town: State: Postcode: Phone numbers Business hours: After hours: address Public Liability insurance details note $10,000,000 PL required Applicant signature Date:.../.../... Part 2 Site details Is your stall to be located on the road reserve or on your private property? Proposed roadside stall street address Road reserve Private Property Number and Street Name Suburb State: Postcode Is your roadside stall any of these things? A van or trailer A tent A built structure (please specify): Registration details of van or trailer (if applicable)... 3

4 Are there any existing structures or services on the site either above ground or underground? Note: See the Roadside Stall Guidelines for the Dial Before You Dig hotline. Safety and vandalism Identify any significant safety or crime concerns How do you plan to address these concerns? Does the site have good visibility from nearby houses or businesses? Location How many kilometres is the site from any food retail outlet? Note: In general applications for street stalls in the urban / town / village areas will be accepted from community groups fundraising for local causes and single product stalls What is the sign-posted speed limit on the road where your roadside stall will operate? 4

5 Size Is the site of adequate land size to accommodate the roadside stall infrastructure and allow for safe parking for customers? The size of the stall should not exceed eight square metres. Bigger stalls require a Development Application. Part 3 Roadside stall details It must be demonstrated that there is adequate commitment and capacity to plan and establish the roadside stall and provide for its ongoing maintenance. What is the purpose(s) of the proposed roadside stall (tick as many as applicable)? Farm gate income Fundraising Improved access to healthy food Sustainability education Other (specify) What do you intend to sell at your roadside stall and will it be sold in a wrapped or unwrapped form, hot or cold? In the case of unwrapped foods, how do you intend to protect it against contamination? In the case of food requiring temperature control, how do you intend to keep it hot or cold? Packaged foods i.e. jars and packets Fresh fruit, vegetables, nuts Meat Craft items Plants Other (please specify) 5

6 In the case of packaged foods i.e. jars and packets, describe how the package will be labelled in compliance with the Food Safety Standards. Please refer to the Roadside Food Stall Guidelines or ndards.gov.au/ for details What hours do you intend to operate this roadside stall? Will you (Please tick one) Stay with the stall during operational hours? Have the stall unmanned at all times? Sometimes have the stall manned & sometimes unmanned? How do you plan to keep the roadside stall tidy? How has the surrounding community been consulted about the proposed roadside stall and what were the outcomes? 6

7 Part 4 Declaration I hereby certify that I will accept all responsibility under the Food Act 2003, as the proprietor / director of this roadside stall /.../... Signature of Proprietor/s Date Part 5 Lodgement details You can lodge the completed form with any supporting material as follows: By (Insert Address) By Mail: (Insert address) Or for further information or assistance with your application, please contact: (Insert title, name and contact details of responsible staff member) OFFICE USE ONLY Approval to Issue: Yes No Date Approved:.. /.. /.. Signature: PUBLIC HEALTH OFFICER 7

Food Act 1984 (Vic) Application to register food vending machines

Food Act 1984 (Vic) Application to register food vending machines This form is to be used to apply for state-wide registration of one or more food vending machines from which a business sells food. Under