Health and wellbeing premises registration form


Please complete and submit to register a premises under the Public Health & Wellbeing Act.




 

Premises address details

Start typing in your street address, then select it from the list.
  
 
This email address will be our primary means of contact with your business.
  

Proprietor details


 

Other information

Health premises details









 

Plans or photos

Select file to upload (doc,docx,pdf,jpg,gif,xls,xlsx,ppt,pptx,txt,rtx). File size limit: 25MB
  
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Open the calendar popup.
 

Fees

The fees for your application may vary according to the level of food risk. More information can be found on our fees page.

We will invoice you for any fees related to your business and the payment of this invoice required for your application to proceed.

Statement

You understand that:

  • the information provided in the application is true and complete, to the best of your knowledge
  • this application forms a legal document and penalties exist for providing false and misleading information
  • We, City of Greater Geelong, may refuse this application if it becomes evident that any information or supporting documents provided are incomplete or false
  • where the commercial activities are located with a predominantly residential land use, we will apply a Mixed Use rate which is lower than the commercial rate but higher than the residential rate; the current rates are available in our Rating Strategy
  • by ticking this box, you confirm that you are the person named above.
 

Privacy

This information is collected under the requirements of the Food/Public Health & Wellbeing Act for enforcement of Public Health purposes.

It may be provided to the Department of Health for the same purposes, and for the statistical purposes related to the application of the Act.

It will be treated in compliance with the Department of Health Information Privacy Principles and the Information Privacy Act.