Application Form FA13P Recognition of a Person under the Food Act 2014

Transcription

1 Approvals Operations Group Regulation and Assurance Ministry for Primary Industries Pastoral House, 25 The Terrace PO Box 2526, Wellington, New Zealand 6140 Tel: , fax: Application Form FA13P Recognition of a Person under the Food Act 2014 Before you start, let s check that you have everything you need: All applicants need to demonstrate knowledge and understanding of the applicable requirements of the Act as per Regulation 114(2) of the Food Regulations Further information will be provided by MPI upon application. If you are an independent person (i.e. not employed, engaged or managed by a recognised agency), you need to be able to demonstrate that your written quality management system complies with Regulation 110(2) of the Food Regulations If you intend to be an evaluator or verifier of custom food control plans, you must submit a copy of the assessment report from IANZ or JAS-ANZ demonstrating ISO accreditation has been granted. If you will be solely involved in providing verification of template 1 food control plans or businesses under a national programme, submit an assessment or written evidence to confirm that your quality management system complies with Regulation 110(2). See Information for regulators & verifiers for more information. If you are applying to be an evaluator or a verifier of custom food control plans, you will have undergone an individual assessment as part of your agency s ISO accreditation. Submit a copy of your individual assessment, according to the flow diagram below. See Information for regulators & verifiers for more information. If you have not undergone any form of individual assessment, do not continue with this application until you have. Yes Have you had an individual assessment by an Accreditation Body (IANZ or JAS-ANZ)? Don t know No Attach the report from your accreditation body to your application. Yes Is your agency under the Key Technical Personnel (KTP) model? No Don t know See food-safety/foodact "Information for regulators & verifiers" for more information Attach signed copies of KTP recommendation reports, as detailed in QMS guidance. See mpi.govt.nz/food-safety/ foodact "Information for regulators & verifiers" for more information Do not submit this form to MPI until you have been assessed by an accreditation body. 1 Relates only to template food control plans for which territorial authorities are not exclusive verifiers under section 137 of the Food Act 2014

2 If you are applying solely to be a verifier of template 1 food control plans or of businesses subject to national programmes, submit evidence of your knowledge and understanding as per Regulation 114(2) of the Food Regulations 2015, according to the flow diagram below. See Information for regulators & verifiers for more information. If you have not completed any form of individual assessment, do not continue with this application until you have. Yes Have you had an individual assessment by an Accreditation Body (IANZ or JAS-ANZ)? Don t know No Attach the report from your accreditation body to your application. Yes Is your agency under the Key Technical Personnel (KTP) model? No Don t know See food-safety/foodact "Information for regulators & verifiers" for more information Attach signed copies of KTP recommendation reports, as detailed in QMS guidance. See mpi.govt.nz/food-safety/ foodact "Information for regulators & verifiers" for more information Submit written evidence of knowledge and understanding. See mpi.govt.nz/food-safety/ foodact "Information for regulators & verifiers" for more information If you were approved as an auditor under the Food Act 1981 by Ministry for Primary Industries (MPI) before 1 March 2016, make sure you have your previous approval ID on hand. If you are or have been recognised by MPI under other legislation (such as the Animal Products Act 1999), make sure you have the recognition ID(s) on hand. Your application fee of (incl. GST). Read these notes before you start filling out the form This form must be used when applying to MPI for recognition as a person under section 139 of the Food Act Use this form if you are applying for recognition as a natural person. Information provided may be included on the public register. However you can ask for certain personal information (specified in Clause 9, Part 7 of Schedule 5 to the Food Act 2014) to be withheld from the published register. We will tell you where you can choose that option. You can view the public register on the MPI website, under Registers and Lists. Send the completed application form together with the fee and other requirements above to MPI at the above address. We prefer files. This icon is used when you need to make a decision. The question will help you decide whether you need to complete a particular section. Throughout this form you will need to tick boxes that look like this: A checked box indicates a yes answer. If there are any changes to the details provided in this application after the application has been sent to MPI, you must promptly inform us of the changes in writing. You may be required to provide additional information to that you supply in this form. April 2018 Page 2 of 13 FA13P: Recognition of a Person

3 Approvals Operations Group Regulation and Assurance Ministry for Primary Industries Pastoral House, 25 The Terrace PO Box 2526, Wellington, New Zealand 6140 Tel: , fax: Application Form FA13P Recognition of a Person under the Food Act I want to apply for recognition as an: Complete for all applications. Tick all that apply. Evaluator of food control plans complete section 2 Verifier of custom food control plans complete section 3 Verifier of template* food control plans complete section 4 Verifier of businesses under a national programme complete section 5 * relates only template food control plans for which territorial authorities are not exclusive verifiers under section 137 of the Food Act Evaluators of food control plans - my recognition needs to cover the following categories All evaluators receive Generic category; this has been ticked for you. Tick Special Categories that apply. See Information for regulators & verifiers for more information about the categories and sectors/processes they cover. Generic (all evaluators)* + Special Categories: Aseptic processing and packaging attach confirmation of course completion as per Food Notice: Recognised Agencies and Persons Low acid canned food processing attach confirmation of course completion as per Food Notice: Recognised Agencies and Persons * Covers all sectors/processes except Special Categories + Recognised person will be responsible for employing technical experts when evaluating areas that are outside their expertise. 3. Verifiers of custom food control plans - my recognition needs to cover the following categories All verifiers of custom food control plans receive Generic category; this has been ticked for you. Tick any Special Categories that apply. See Information for regulators & verifiers for more information about the categories and sectors/processes they cover. Generic (all verifiers)* + Special Categories: Aseptic processing and packaging attach confirmation of course completion as per Food Notice: Recognised Agencies and Persons Low acid canned food processing attach confirmation of course completion as per Food Notice: Recognised Agencies and Persons * Covers all sectors/processes except Special Categories + Recognised person will be responsible for employing technical experts when verifying areas that are outside their expertise.

4 4. Verifiers of template food control plans - my recognition needs to cover the following categories All verifiers of food control plans receive Generic category; this has been ticked for you. Tick any Special Categories that apply. This relates only to template food control plans for which territorial authorities are not exclusive verifiers under section 137 of the Food Act See Information for regulators & verifiers for more information about the categories and sectors/processes they cover. Generic (all verifiers)* + Special Categories: Aseptic processing and packaging attach confirmation of course completion as per Food Notice: Recognised Agencies and Persons Low acid canned food processing attach confirmation of course completion as per Food Notice: Recognised Agencies and Persons * Covers all sectors/processes except Special Categories + Recognised person will be responsible for employing technical experts when verifying areas that are outside their expertise. 5. Verifiers of businesses under national programme - my recognition needs to cover the following categories Tick one or other (not both). See Information for regulators & verifiers for more information about the categories and sectors/processes they cover. Limited (covers food service, retail, and logistics only); OR Generic (covers all National Programme sectors/processes) + + Recognised person will be responsible for employing technical experts when verifying areas that are outside their expertise. Question A: Prior to 1 March 2016, were you approved as an auditor under the Food Act 1981? Or are you/have you been recognised by MPI under other legislation? Yes Complete section 6. No Go straight to section Previous IDs If an existing auditor with a deemed recognition, or a recognised person under other legislation, enter current approval ID number: April 2018 Page 4 of 13 FA13P: Recognition of a Person

5 7. Applicant Full Legal Name Complete for all applications. 8. Business Address and Contact Details Complete for all applications. If the address is a dwellinghouse, you may ask that the address is withheld from the public register by ticking the box below. Postal Address Address: Physical / Courier Address (if different to Postal Address) Address: Town/City: Postcode: Country: This address is a private dwellinghouse and I wish it to be withheld from the public register. Town/City: Postcode: Country: This address is a private dwellinghouse and I wish it to be withheld from the public register. By entering an address you consent to being sent information and notifications electronically, if required. Mobile telephone no. Other telephone no. Question B: Are you employed by a recognised agency(ies)? Yes Complete section 9. No Complete section I work for the following recognised agency(ies) Include all that apply. You can view the public register at under Registers and Lists. If your agency is not yet recognised, but has submitted an application with MPI, note that here. I confirm I have knowledge and understanding of and comply with the written quality management system for each agency listed above. Tick the applicable documents that are included with your application. Attach relevant assessment report(s) for each agency you work for. Ensure your assessments cover any special categories of recognition: Additional technical competencies evidence attached (if applicable); IANZ/JAS-ANZ individual assessment report attached; or, KTP individual assessment reports attached; or, Written evidence attached demonstrating knowledge and understanding*. * Only available to persons solely involved in providing verification of template food control plans or businesses under a national programme. April 2018 Page 5 of 13 FA13P: Recognition of a Person

6 10. I am an independent person Tick the applicable reports that are included with your application. Ensure your assessments cover any special categories of recognition. Additional technical competencies evidence attached (if applicable); and IANZ/JAS-ANZ individual assessment report attached; or, KTP individual assessment reports attached; or, Written evidence attached demonstrating knowledge and understanding*. * Only available to persons solely involved in providing verification of template food control plans or businesses under a national programme. Independent person - Quality Management System Tick as applicable. Accredited to ISO 17020* report attached. Not accredited to ISO 17020** documentation demonstrating compliance with Regulation 110(2) of the Food Regulations 2015 attached. I confirm I have knowledge and understanding of and comply with my written quality management system. * All independent persons, who wish to evaluate or verify custom food control plans or businesses operating under custom food control plans, must be accredited to ISO see Regulation 115(1)(b) of the Food Regulations ** Only available to independent persons solely involved in providing verification of template food control plans or businesses under a national programme. 11. Suitability of applicant (fitness and propriety - character, integrity and reputation) Complete for all applications. I have attached completed and signed Appendix 1: Vetting Service Request and Consent Form; and I aware of any matters which might adversely affect my suitability for recognition (attach details of any relevant matters); and To the best of my knowledge I have no pending criminal charges; or I have pending criminal charges (attach details of any known pending criminal charges). Detail any other relevant information (indicate if further information is attached): Explanatory notes: (1) The Director General of MPI may not recognise a person under the Food Act 2014 unless s/he is satisfied that the applicant is a fit and proper person to carry out such activities. Some criminal convictions, particularly those involving dishonesty, may be relevant to the assessment of whether you are a fit and proper person to hold this recognition. (2) The Director General has the power to withdraw a recognition for a person if s/he is satisfied that the person is not a fit and proper person to carry out evaluations or verifications, or has failed to comply with a condition of their recognition, or has failed to comply with the Food Act 2014, applicable regulations or notices. (3) If MPI subsequently becomes aware of information that is relevant to a person s recognition which was not disclosed in this application or which arises in the future, the Director General may suspend or withdraw that person s recognition. April 2018 Page 6 of 13 FA13P: Recognition of a Person

7 12. Applicant Statement Complete for all applications. We accept PDF or scanned versions of signatures. I confirm that: 1. The information supplied in this application is accurate and complete; and 2. I authorise MPI to make such inquiries as it considers necessary to enable it to consider my suitability for recognition, including matters relevant to my competence, and my fitness and propriety. 3. If I am recognised under the Food Act 2014, I accept that I have a continuing obligation to disclose to MPI any matters that may arise in the future which may be relevant to my continued suitability to hold such recognition. This includes (but is not limited to) Police or disciplinary investigations. 4. There is no other information I am aware of that affects my ability to maintain an appropriate degree of impartiality and independence in managing the functions and activities for which I have applied to be recognised. Name Job Title Question C: Have you completed section 10 (i.e., you are an independent person and not operating under a recognised agency)? Yes Go straight to section 14. No Your manager(s) must complete section 13. April 2018 Page 7 of 13 FA13P: Recognition of a Person

8 13. Manager Statement We accept PDF or scanned versions of signatures. A manager from each agency listed in section 9 will need to confirm the statement below. Add as many agencies as necessary, or attach additional pages with confirmation statements. I confirm that: 1. I am satisfied that the applicant is competent (has appropriate qualifications, skills and practical experience) for the recognition ticked in section 1 and the categories listed in section 2-5. I undertake to ensure that these competencies are maintained. 2. I am satisfied that the applicant is a fit and proper person to be recognised. 3. I am not aware of any matter* that might adversely affect the suitability of the applicant for recognition. *Any additional information related to matters that may be perceived as adversely affecting the suitability of the applicant for recognition must be attached to this application. 4. I undertake that I will notify MPI without delay if I become aware of any matters that may be relevant to the suitability (covering fitness, propriety and competence) of the applicant to continue to hold this recognition I am satisfied that the applicant has knowledge and understanding of and is able to comply with the agency s written quality management system. I undertake to ensure that this knowledge and understanding is maintained. I recommend the applicant for recognition. Name Name Name Name Name Agency Name Agency Name Agency Name Agency Name Agency Name April 2018 Page 8 of 13 FA13P: Recognition of a Person

9 14. MPI Service Charge Complete for all applications. ON PAYMENT THIS BECOMES A TAX INVOICE GST No: New Person 1.25 hours $ Note: In addition to the application fee above, an assessment time fee based on an hourly rate of $ (incl. GST) per hour or $44.56 (incl. GST) per 15 minutes may be charged in instances where applications take longer to process. PAYMENT OPTIONS: Payments comprising multiple fees must be supported by a remittance advice. Please attach your advice to this application or send it separately to: MPI Approvals, PO Box 2526, Wellington MPI does not accept cash. Payment must be made using one of the following methods. (Please tick and fill in the appropriate section.) DIRECT CREDIT: 1. Pay into Bank Account no In the Reference details, put the name of the person 3. Enter the date of deposit and your name (payee) on this form below: of Deposit Your Name (Payee) CHEQUE: 1. Make the cheque payable to Ministry for Primary Industries. 2. Attach the cheque to this application. CREDIT CARD: 1. Choose the type of card you wish to use: VISA MasterCard 2. Fill in the card details below: Card No: Name on Card Expiry 15. Final Check and Document Package to send to MPI Have you: filled this form in completely and legibly? submitted a copy of your individual assessment report(s)? included evidence of competency for any required activities? included fee payment for this application? read and signed the Applicant Statement? completed Vetting Service Request and Consent Form (Appendix 1)? April 2018 Page 9 of 13 FA13P: Recognition of a Person

10 Collection of Information Collection of Personal Information Pursuant to Principle 3 of the Privacy Act 1993, we advise that: This information is being collected for the purpose of determining whether a person should be granted recognition as a recognised person under the Food Act 2014; and The recipient of this information, which is the agency that will collect and hold the information, is MPI, PO Box 2526, Wellington 6140; and Some of the information collected will be displayed on a public register; and The collection of information is authorised under section 143 of the Food Act The provision of this information is necessary in order to process an application for recognition; and The supply of this information is voluntary; however, failure to provide the requested information is likely to result in a return of this application form to the applicant, and may ultimately result in a refusal to recognise in accordance with section 145 of the Food Act 2014; and Under Principles 6 and 7 of the Privacy Act 1993, you have the right of access to, and right to request correction of, any personal information that you have provided. Collection of Official Information All information provided to MPI is official information and may be subject to a request made under the Official Information Act If a request is made under that Act for information you have provided in this application, MPI will consider any such request, taking into account its obligations under the Official Information Act 1982 and any other applicable legislation. April 2018 Page 10 of 13 FA13P: Recognition of a Person

11 Appendix 1 Vetting Service Request & Consent Form NZPVS-CS - 03/18 Section 1: Approved Agency to complete (For more information please see the Guide to Completing the Consent Form - Name of Approved Agency submitting vetting request: Name of Applicant to be vetted: Description of Applicant s role: Applicant s purpose Employee Contractor/Consultant Volunteer Prosecution Vocational Training Licence/Registration Visa/Work Permit Other What group(s) will the applicant have contact with in their role for your agency? Children/Youth Elderly Other Vulnerable Adults Other What is the applicant s primary role for your agency? Caregiving (Children) Caregiving (Vulnerable adults) Healthcare Education Other Is this request mandatory under the Vulnerable Children Act 2014 (VCA)? Yes (VCA Core Worker) Yes (VCA Non-Core Worker) No (mandatory under other legislation/optional/standard Police Vet) If this is a mandatory Vulnerable Children Act request, please specify the check reason below: New Children s Worker Existing Children s Worker VCA Renewal Evidence of Identity (to be completed by agency representative/delegate or identity referee - see guide for details) A primary ID has been sighted (Mandatory see the guide for further details) A secondary ID has been sighted (Mandatory see the guide for further details) One form of ID is photographic (Mandatory see the guide for further details) Evidence of name change has been sighted (if applicable) OR: If your organisation is able to accept a verified RealMe identity then: An assertion of a RealMe identity has been received (see guide for further information). In making this request, I confirm that: I have complied and will comply with the Approved Agency Agreement I am satisfied with the correctness of the applicant s identity I have obtained the Applicant s authorisation to submit this vetting request as set out in section 3 of this form Approved Agency Authorised Representative: Name: : : Electronic Page 11 of 13

12 Vetting Service Request & Consent Form NZPVS-CS - 03/18 Name of Approved Agency submitting vetting request: Section 2: Applicant to complete and return to Approved Agency *Denotes a mandatory field Personal Information Details (note: the name you are most commonly known by is your primary name) *Family name (Primary): Given name(s): *Gender: (M) (F) (Other) * of birth: (dd/mm/yyyy) Place of birth: (Town/City/State) *Country of birth NZ Driver Licence number: Previous names: If applicable, please include other alias or alternate names; married name if not your primary name; previous/maiden/name changed by deed poll or statutory declaration. Family name First name Middle names Permanent Residential Address *Number/Street: Suburb: Post Code: *City/Town/ Rural District: Page 12 of 13

13 Vetting Service Request & Consent Form NZPVS-CS - 03/18 Section 3: Applicant to complete and return to Approved Agency Consent to release information 1. The New Zealand Police may release any information they hold relevant to the purpose of this vetting request. This includes: Conviction histories and infringement/demerit reports Active charges and warrants to arrest Charges that did not result in a conviction including those that were acquitted, discharged without conviction, diverted or withdrawn Any interaction I have had with New Zealand Police considered relevant to the role being vetted, including investigations that did not result in prosecution Information regarding family violence where I was the victim, offender or witness to an incident or offence, primarily in cases where the role being vetted takes place in a home environment where exposure to physical or verbal violence could place vulnerable persons at emotional or physical risk. Information subject to name suppression where that information is necessary to the purpose of the vet 2. If I am eligible under the Criminal Records (Clean Slate) Act 2004, my conviction history will not be released unless: a. Section 19(3) of the Clean Slate Act applies to this request (exceptions to the clean slate regime) b. Section 31(3) of the Vulnerable Children Act 2014 applies to this request (safety checks of core children s workers). c. The vetting request is made by an individual for the purpose of an overseas Visa/Work Permit as a Privacy Act request authorising the vetting result to be provided directly to the relevant embassy, high commission or consulate. Please see the guide for more information regarding the Clean Slate legislation. 3. The Police Vetting Service may disclose new relevant information to the Approved Agency after the completion of the Police Vet in the following circumstances: The disclosure of the newly-obtained information is considered to be justified under the Privacy Act 1993 (if it had existed or been available at the time of the Police vet, it would have been disclosed); and The Police Vetting Service has ascertained that the purpose of the Police vet (e.g. employment role) still exists. The Vetting Service will endeavour to notify you prior to the disclosure. 4. Information provided in this consent form may be used to update New Zealand Police records. 5. I am entitled to a copy of the vetting result released to the Approved Agency (to be provided by the agency) and can seek a correction by contacting the Vetting Service. 6. The Approved Agency will securely dispose of this consent form, copies of identification documents and the vetting result within 12 months of receiving the result unless a longer retention period is required by legislation. 7. I may withdraw this consent, prior to Police s disclosure of the vetting result, by notifying the Approved Agency. For further information, please see the Guide to Completing the Consent Form. Applicant s Authorisation: I confirm that the information I have provided in this form relates to me and is correct. I have read and understood the information above. I authorise New Zealand Police to disclose any personal information it considers relevant to my application (as described above) to the Approved Agency making this request for the purpose of assessing my suitability at any time. Name: : : Electronic Page 13 of 13