Title Page
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Licence holder
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Contact person
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Assessment no
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Health premises no
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Date
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Inspection Frequency
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Prepared by
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Premises address
Licence details
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Type of licence
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Number of long stay sites on licence
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Actual number of long stay sites
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Number of short stay sites on licence
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Actual number short stay of sites
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Number of camping sites on licence
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Actual number of camping sites
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Short stay over flow sites on licence
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Actual number of short stay overflow
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Long stay overflow sites on licence
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Actual number of long stay overflow sites
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Number of camping overflow on licence
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Actual number of camping overflow sites
Duties of licence holder
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plan of facility
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facility licence displayed
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facility rules
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emergency contact
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register of occupiers
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office hours
Buildings on facility
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manager’s house
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office
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toilets, ablution blocks, laundry
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workshop
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other buildings (approved)
Roads and parking
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entrance road minimum width 6m
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one way road minimum width 4m
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two way road minimum width 6m
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car parking area provided
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one parking bay per 20 caravan sites
Recreational area
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1/10 of facility provided for recreational area
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2/3 of recreational area in one area
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weather protected recreational area provided
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building for communal/recreational activities
Ablution and toilet facilities
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toilet and shower within 90m of each site
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shower cubicles provided with:
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• dressing area
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• lockable door that opens outwards or can be removed from the outside
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• seat
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• clothes hook
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• hot and cold water
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• ventilation
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babies bath provided with
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• 45L capacity trough, drain, plug
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• 0.45m2 bench space
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• hot and cold mixer tap (maximum temperature 38°C)
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• at least one accessible baby bath
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hand basin provided with:
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• hot and cold water
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• hooks
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• mirror
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• shelving
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• power points (1 per 4 hand basins)
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• at least one accessible hand basin
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• at least on accessible power point
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toilet cubicles provided with
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• toilet roll dispenser
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• coat hook
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• lockable door that opens outwards or can be removed from the outside
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• ventilation
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• napkin disposal unit (1 per 10 toilets)
Toilet, shower and hand basin audit
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NOTE: a site with an ensuite is not included, 2 camp sites are equal to one site
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number of sites:
MALE Toilets, Showers and Hand Basins
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Male Toilet Items
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Specify Item to be inspected
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Condition
Male Shower Items
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Specify Item to be inspected
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Condition
Male Hand Basin Items
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Specify Item to be inspected
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Condition
FEMALE Toilets, Showers and Hand Basins
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Female Toilet Items
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Specify Item to be inspected
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Condition
Female Shower Items
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Specify Item to be inspected
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Condition
Female Hand Basin Items
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Specify Item to be inspected
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Condition
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General Comments
Laundry facility audit
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Number of sites:
Amenity block
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Specify
Washing machines
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Specify
Troughs
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Specify
Clothes dryers (or 60m of washing line)
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Specify
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Comments
Laundry facilities
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laundry facilities provided with:
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• hot and cold water
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• slop hopper
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• bench space (0.3m2)
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• entry door type and width accessible
Washing up facilities
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one trough per 20 camp sites
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trough within 90m of each campsite
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trough provided with
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• hot and cold water
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• 45L capacity
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0.5m2 bench
Lighting
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ablution block lighting satisfactory
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laundry facilities lighting satisfactory
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grounds lighting satisfactory
Fire fighting
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every site within reach of fire hose
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fire hose reels satisfy Australian Standard
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fire hydrants provided for park homes
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fire extinguishers (1 per 6 sites)
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fire extinguishers satisfy Australian Standard
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every site within 30m of fire extinguisher
Electricity
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caravan sites provided with electricity
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long stay sites provided with electricity meter
Water supply
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every camp site within 30m of a tap
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every short stay site within 10m of tap
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every long stay site provided with tap
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300L water/day/site available
Wastewater, sewage and drainage
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every caravan site within 10m of sullage point
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every camp site within 30m of sullage point
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sewage connection points provided for long stay sites with ablution facilities
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communal chemical dump point provided
Rubbish
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every site within 90m of rubbish bin
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rubbish bins not less than 80L capacity
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rubbish bins emptied regularly, kept clean
Telephone
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telephone available
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long stay sites/ park homes provided with phone connection
Postal service
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long stay sites provided with mailbox
Solid fuel fires
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no solid fuel appliances in caravans
Sign Off
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Officer name and Signature
