Notice / Food Act 2006 /

Notice of auditor’s interest in a food business

1. Applicant Details
Title / Mr Ms Mrs Miss Dr / Approval no. / FSA/
Given names (do not abbreviate) / Surname
Residential address
2. Type of interest
Indicate the type of interest you have in the food business.
Direct financial interest in a food business
/
Indirect financial interest in a food business
Other interest in a food business
3. Details of the interest
Provide full details of your interest in a food business, including identifying details of the food business.
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4. Declaration
I declare that the information stated in this application form to the best of my knowledge is true, correct and complete. / Yes No
Signature / Date
Privacy Statement: The Department of Health provides this form under the Food Act 2006 so that an auditor may give notice to the chief executive of their interest in a food business. The information and documents collected for the purpose of this form may be accessible by appropriately authorised officers of the department or its agents. The department will not disclose your personal information or supporting documents to third parties without your consent unless required or authorised by law.
The Information Privacy Act 2009 sets out the rules for the collection and handling of personal information by the Department of Health. For information about how the Department of Health protects your personal information, or to learn about your right to access your own personal information, please see our website at www.health.qld.gov.au.


Return the completed application to: Food Safety Standards and Regulation

PO Box 2368

FORTITUDE VALLEY BC QLD 4006

or

Further information

1.  Further information is available via the Queensland Health food safety website www.health.qld.gov.au/foodsafety.

2.  Enquiries can be directed to Food Safety Standards and Regulation by phone (07) 3328 9310 or email .

September 2015: Notice – Auditor conflict of interest / - 2 - /