Name of Organisation
How many people will be helping/handling food?
Contact Person
Contact Person's address. Please include Street/Rapid number, road name, Rural Delivery number (if applicable) and Post Code. Click here to find post code
Contact Person's Email address
Contact Person's Tel. No.
Where will food be sold?
Date when food will be sold
Has the land owner's permission been given?
Raw food purchased from ..
Type of food being prepared	Other:
Address where food will be prepared
Is food wrapped prior to sale?
Type of wrapping used
How will food be stored after preparation?
How will food be transported?
How will food be stored on site?
What protective clothing is to be worn by food handlers?	Aprons Hats Gloves Other
Are hand washing facilities available and where?	Location
Are toilet facilities available?	Location
How will refused be disposed of?

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	Clutha District Council, 1 Rosebank Tce, PO Box 25, Balclutha 9240 P: 0800 801 350 \| F: 03 418 3185 \| E: help.desk@cluthadc.govt.nz Some of this website may be subject to copyright � Clutha District Council 2012