Accommodation Assessment

• Audit Title

• Proprietor

• Conducted on

  Date

• Prepared by

• Location
  Address

General Information

• Date and Time audit began

  Date

• Name of Premises

• Name of proprietor or staff member in attendance

• Name of Authorised Officer conducting assessment

  Select Kelly Mahoney Kevin Murphy Ewen Ross

  • Kelly Mahoney
  • Kevin Murphy
  • Ewen Ross

• Reason for assessment

  Select Scheduled Inspection Follow Up Inspection Complaint Inspection Transfer Inspection Routine Inspection Registration

  • Scheduled Inspection
  • Follow Up Inspection
  • Complaint Inspection
  • Transfer Inspection
  • Routine Inspection
  • Registration

General Area

• Is the premises in a good state of repair?

  Yes

  No

  N/A

• Is the premises in a clean, sanitary and hygienic condition?

  Yes

  No

  N/A

• Lighting adequate and operational

  Yes

  No

  N/A

• Area is free from odours

  Yes

  No

  N/A

• Noise level is acceptable/adequately controlled

  Yes

  No

  N/A

• Ventilation is adequate

  Yes

  No

  N/A

• Stair treads in good condition

  Yes

  No

  N/A

• Electrical switches/sockets in good condition

  Yes

  No

  N/A

• Furniture safe and undamaged

  Yes

  No

  N/A

Room size requirements

• Does each habitable room meet the overcrowding requirements?

  Yes

  No

  N/A

• Is the plan on file similar to that of the inspected premises?

  Yes

  No

  N/A

• Maintaining a register

  Yes

  No

  N/A

Emergency

• Access and egress paths clear

  Yes

  No

  N/A

• Fire fighting equipment easily accessible

  Yes

  No

  N/A

• Fire fighting equipment checked in last 6 months

  Yes

  No

  N/A

• Adequate lighting and exit signage?

  Yes

  No

  N/A

• Does the premises contain or require interlinked smoke detectors.

  Not required

  Installed

  Not installed

  Battery operated smoke detectors

  Unknown

Kitchen

• Drains (floor and sink) clear and free flowing

  Yes

  No

  N/A

• Fridge clean, good condition

  Yes

  No

  N/A

• Microwave clean and maintained

  Yes

  No

  N/A

• Oven/stove safe and clean

  Yes

  No

  N/A

• Area free from pests or evidence thereof

  Yes

  No

  N/A

Safe water supply

• Is the drinking water adequately treated?

  Town water supply

  Chlorination

  UV Treatment

  Unknown

  Not Treated

• Continuous and adequate water supply to all toilet, bathing, laundry and drinking water facilities?

  Yes

  No

  N/A

• Continuous and adequate supply of hot water to all bathing, laundry and kitchen facilities?

  Yes

  No

  N/A

Sewage and Waste Water

• Type of sewage system used

  Town Sewer

  Septic

  Treatment Plant

  Unknown

• Sewage system adequate for the style of operations?

  Yes

  No

  N/A

External

• Seating available and safe

  Yes

  No

  N/A

• Tables safe and clean

  Yes

  No

  N/A

• Waste and cigarette butt bins available

  Yes

  No

  N/A

• Cooking area clean and free from waste/rubbish

  Yes

  No

  N/A

Laundry

• Floor/area free from water and being wet

  Yes

  No

  N/A

COMMENTS OBSERVATIONS

• Comments/Observations

REQUIRED ACTIONS

• Required Actions

INSPECTION OUTCOME

• Inspection Outcome<br>

  Major Non-Compliance

  Critical Non-Compliance

  Marginal

  Complied

Re-inspection Date (if required)

• Re-inspection Date

  Date

Declaration

• Proprietor/staff:
  The above information is true and correct

• Proprietor/Staff

  Sign

• Environmental Health Officer

  Sign