"Meat Processing Licence Application" - Nova Scotia, Canada

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Application
Meat Processing Licence
Office Use Only
Date Received: (yyyy/mm/dd)
Application #
Note: In the event of owner change or business location change this permit is not transferable and
a new licence must be applied for.
Note: The submission of an application with payment does not guarantee application approval.
Type of Application
 New Application (no fee)
If applicable, provide the previous: Licence #
Licence name
1 Applicant
If there is more than one applicant, attach a complete list of applicants with the information below. The first
applicant listed will be considered the primary applicant for this project. You can also apply for your business
number, food establishment permit and food hygiene training through the Access to Business portal at
http://novascotia.ca/mybusiness.
Company/Organization
Business number (BN) (if applicable)
First name
 Middle initial
 Last name
Phone/fax Primary
 Secondary
 Fax
Ext.
Ext.
Email
Website/Social Media page(s) (if applicable)
Civic address
City/town
Province
Postal code
Country
Mailing address
(if different than
civic address)
City/town
Province
Postal code
Country
Preferred method of contact?   Email   Letter
Page 1 of 6
Rev 01Mar2020 Nova Scotia Environment • Food Safety
Application
Meat Processing Licence
Office Use Only
Date Received: (yyyy/mm/dd)
Application #
Note: In the event of owner change or business location change this permit is not transferable and
a new licence must be applied for.
Note: The submission of an application with payment does not guarantee application approval.
Type of Application
 New Application (no fee)
If applicable, provide the previous: Licence #
Licence name
1 Applicant
If there is more than one applicant, attach a complete list of applicants with the information below. The first
applicant listed will be considered the primary applicant for this project. You can also apply for your business
number, food establishment permit and food hygiene training through the Access to Business portal at
http://novascotia.ca/mybusiness.
Company/Organization
Business number (BN) (if applicable)
First name
 Middle initial
 Last name
Phone/fax Primary
 Secondary
 Fax
Ext.
Ext.
Email
Website/Social Media page(s) (if applicable)
Civic address
City/town
Province
Postal code
Country
Mailing address
(if different than
civic address)
City/town
Province
Postal code
Country
Preferred method of contact?   Email   Letter
Page 1 of 6
Rev 01Mar2020 Nova Scotia Environment • Food Safety
Application
Meat Processing Licence - continued
2 Additional Contact Information
Is the Application Contact the same as Section 1?   Yes   No  If yes, skip to Section 3.
If there is more than one contact, attach a complete list of contacts with the information below.
First name
 Middle initial
 Last name
Contact title
Phone/fax Primary
 Secondary
 Fax
Ext.
Ext.
Email
Civic address
City/town
Province
Postal code
Country
Mailing address
(if different than
civic address)
City/town
Province
Postal code
Country
Return correspondence?   Yes   No
Note: Following application decision, all correspondence will go to the applicant.
Preferred method of contact?   Email   Letter
3 Meat Processing Facility Site/Location
Meat Processing Facility name
Civic address
City/town
Province
Postal code
Country
Property Identification # (PID), if known
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Rev 01Mar2020 Nova Scotia Environment • Food Safety
Application
Meat Processing Licence - continued
4 Activity Details
Proposed Operating Schedule
Hours/Day (e.g. 8am -5pm)
 Days/Week (e.g. Mon - Fri)
 Weeks/Year (e.g. 50)
Planned facility start date/opening date, (yyyy/mm/dd)
Is this a seasonal operation?    Yes   No
Seasonal operating start date (Seasonal only)
Seasonal operating end date (Seasonal only)
5 Meat Processing Licence Application Checklist
Supporting Documentation
This checklist and all supporting documentation is to be submitted with the application. However, additional
information may be requested.
If supporting documentation is of poor quality or incomplete, the application may be delayed, returned or rejected.
Answer all the following questions.
1. a. Have you submitted a detailed floor plan with your application which includes the items listed below?
 Yes   No
b. Check off that the detailed floor plan includes the following details:
 building square footage
 location of staff washroom(s)
 location of janitorial facilities
 locations of all equipment including dishwashing equipment, handwashing sink(s), etc.
 materials used for surfaces (floors, walls, ceiling, prep surfaces etc.)
 complete physical separation between raw and ready to eat processing areas
2. a. Have you submitted a list of Products and/or a Menu which will be served at the facility?
 Yes   No
b. Check off that the list of products or menu includes the following details:
 intended products (include any seasonal items)
 intended supplier(s) and/or licensed abbatoir (include plant #)
 intended locations of where product will be sold (distribution at a retail location,
farmer’s market, wholesale)
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Rev 01Mar2020 Nova Scotia Environment • Food Safety
Application
Meat Processing Licence - continued
3. Have you submitted a list of Individual Product Recipes and Processing Steps?   Yes   No
4. Is the proposed facility serviced by Municipal drinking water?   Yes   No  If yes, skip question 5.
5. Have you submitted recent Bacterial Water Test Results?   Yes   No
6. Is the proposed facility serviced by an on-site sewage disposal system?  Yes  No If no, skip question 7.
7. a. Have you submitted a Qualified Person 1 (Professional Engineer) Report?   Yes   No
b. If you answered “No” to question 7. a. (above), provide the reason this has not been included.
8. Have you provided copy of valid Food Handler Certification?   Yes   No
9. If you answered ‘No’ to question 8 above, provide the reason this has not been included.
10. Provide any additional information you wish to convey as part of your application (optional).
6 Verify that the following submission items have been included with your application
Submitted
Waiver Requested - Reason
Detailed Floor Plan
Must include:
• building square footage
• location of staff washroom(s)
• location of janitorial facilities
• locations of all equipment including dishwashing
equipment, handwashing sink(s), etc.
• materials used for surfaces (floors, walls, ceiling,
prep surfaces etc.)
• complete physical separation between raw and
ready to eat processing areas
Page 4 of 6
Rev 01Mar2020 Nova Scotia Environment • Food Safety
Application
Meat Processing Licence - continued
Submitted
Waiver Requested - Reason
List of Products and/or Menu
Must include:
• intended products (include any seasonal items)
• intended supplier(s) and/or licensed abbatoir
(include plant #)
• intended locations of where product will be
sold (distribution at a retail location, farmer’s
market, wholesale)
Individual Product Recipes and Processing Steps
Recent Bacterial Water Test Results
(if on private supply)
Qualified Person 1 (Professional Engineer) Report
(if using existing onsite sewage disposal system
and report if required by Public Health Officer)
Copy of Valid Food Hygiene Training
7 Declaration
Information in this application package which the applicant considers to be confidential business information
should be clearly identified.
Are you making this request?   Yes   No
If yes, indicate which information in the Supporting Documentation is considered confidential.
I acknowledge it is an offense under Section 94 of the Health Protection Act and Section 24 of the Meat
Inspection Act to provide false information, and confirm to the best of my knowledge and belief the
information provided in this form and supporting documentation is true and accurate and complies with
the relevant provisions of the Health Protection Act, Meat Inspection Act and Regulations.
Signature of Applicant
 Date
(yyyy/mm/dd)
Name
or
I certify that I am acting with the applicant’s full consent.
Signature
 Date
(yyyy/mm/dd)
Name
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Rev 01Mar2020 Nova Scotia Environment • Food Safety
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