Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
FOOD SAFETY DISCLAIMER
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Food Taken from the Hotel are listed below
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Please list the Food Items taken & Quantity of each item + Attached Photo
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In taking away the food detailed below you acknowledge that you should be responsible for the safe
transportation and storage of the food and understand that the agreement is on the basis that we
accept no liability in respect of this food once removed from the premises.
This food has been prepared according to a hazard analysis system under controlled conditions.
Ideally as with any food taken away from the hotel, we recommend that it is eaten as soon as possible
or refrigerated at or below 5oC within four hours. If you or anyone else requires information on the
types of ingredients used for those who may have an allergic reaction to certain ingredients, please
make the Chef or the Outlet manager aware of this prior to removing the food.
In consideration of our permitting you to take the food away you agree to indemnify and keep
indemnified CROWNE PLAZA MELBOURNE, CARLTON against any and all loss, liability and damage howsoever arising in
respect of such food -
We hereby agree to the above
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Print your Name
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Date that the food was removed from the hotel
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Your Signature
