Officers Name

Time of Inspection/ Date of Inspection

DA Number

Inspection Checklist

1. Sediment Control in place

a) non-existent (issue fine/cleanup notice)

b) ineffective (issue fine/cleanup notice)

c) effective

2. Concrete Pump Permit

Infringement Notice

3. Skip Waste Bin Filteration system in place for discharge into storm water

Bins inspected

Change of bins required

Infringement Notice

4. Crane Permits

Infringement Notice

5. Hoarding Permit Current

Letters Sent

Infringement Notice

6. Obstructions and encroachments on pedestrian access

Public road/nature strip/footpath

Photos taken


Letters sent

Infringement Notice

Permits Current

Vehicles on nature strip

8. Skip Bins

Bin permit current

Place ON road ( Exemption for NO nature strip)

Place OFF road

Lighting provided

Barriers required

Infringement Notice

9. Is the site secured to restrict public access

Letters sent

Infringement Notice

10. Signage (for vacant building site/demolition

Certifiers sign

Builders details

After hours number provided

Letters Sent

11. Significant trees exclusion zone fencing erected

Letters Sent


Full name of contact person (person/site Forman/contractor/spoken to during Inspection

Company Name:

Phone number:

Mobile number:

Fax number:

Postal Address:


Other comments:

Photos taken:

Clean up/ Prevention Notice to be Served:

Infringements to be issued:

Referral Action