Food Safety Supervisor Certificate Record

1. Business Details

Business Name: Sydney Harbour Cafe Pty Ltd Trading Name (if different): The Coffee Dock Business Address: 12 Circular Quay East, Sydney, NSW, 2000 Phone Number: 02 9000 1234 Email Address: manager@coffeedock.com.au

2. Food Safety Supervisor Details

Full Name: Sarah Jenkins Date of Birth: 15/03/1985 Job Title: Head Chef Employee ID (if applicable): HC-042

3. Qualification Details

Registered Training Organisation (RTO) Name: Australian Institute of Food Safety RTO Code: 41127 Statement of Attainment Number: SOA-987654-A Date of Issue: 10/06/2023 Date of Expiry: 10/06/2028

Relevant Units of Competency Completed:

• Use hygienic practices for food safety (SITXFSA005)
• Participate in safe food handling practices (SITXFSA006)
• Participate in safe food handling practices for transport and distribution (SITXINV006)
• Other:

4. Industry Sector

Please select the sector relevant to this business:

• Retail and Hospitality (e.g. Restaurants, Cafes, Takeaways)
• Community and Health Services (e.g. Nursing Homes, Childcare)
• Food Processing (e.g. Manufacturers, Packers)

5. Declaration

I declare that the information recorded above is true and correct. I understand that this certificate must be kept on the business premises at all times and produced for inspection by an authorised officer upon request.

Signature of Food Safety Supervisor: S. Jenkins Date: 12/06/2023

Signature of Business Owner/Proprietor: J. Smith Date: 12/06/2023

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Keep this record in a safe and accessible location on the business premises.