• Document No.

  • Conducted on

  • Prepared By

Reason For Inspection

  • This Inspection

Business Details

  • Premises Name

  • Trading Address

  • Occupier

  • Date / Time

  • Contact

  • Email

  • Phone

  • After Hours Phone

  • Maintenance Contractor

  • Date of Current Disinfection Process

  • Date of Next Disinfection Process Due

Type of Water Cooling System

Location of System

Inspection Safety

  • Easy and Safe Acess


  • Copy Of Maintenance Manuals Provided Near Unit

  • Copy of Operations Manual Provided Near Unit

  • Current Certificate of Disinfection Provided

  • Emergency Startup and Shutdown Procedure Provided

  • Maintenance Work (Worksheet) Noted in Maintenance Manual

  • Comments

Water Cooling System (Cleanliness / Condition)

  • Inspected Monthly

  • Cleaned Every 3 Months

  • Cleaned After Seasonal Shutdown

  • Sampled Every 3 Months - Certificates of Analysis Provided In Manual

  • Automatic Waste Water Bleed Provided

  • Water Basin Satisfactory

  • Drift Eliminators Satisfactory

  • Constructed of Corrosion Resistant Materials

  • Waste Water Discharged to Sewer


Further Action Required

  • Re-Inspection Required

I have Read and Understood The Content

  • Contractors Name and Signature

  • Environmental Health Officer Name and Signature

For Further Information Please Contact Council's Environmental Health Officer Monday to Friday During Business Hours.

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