Title Page

  • Trading as / Location

  • Conducted on

  • Officer

  • Address
  • Premises telephone number

  • Mobile phone number

  • Email address



  • Proprietor

  • Interviewed

  • Manager

  • Interviewed

  • Number of Staff

Model Licence Conditions


  • Licence on display

  • Adequate insurance


  • Walls compliant

  • Floors compliant

  • Ceilings compliant

  • Doors compliant

  • Windows compliant

  • Drainage compliant

  • Lighting compliant

  • Ventilation compliant



  • Maximum number of cats

  • Number of units

  • Sleeping areas

  • Exercise areas


  • Maximum number of dogs

  • Number of units

  • Sleeping areas

  • Exercise areas


  • Are staff adequately trained

  • Is there adequate temperatures

  • Is the premises clean

  • Adequate food and water supplies

  • Adequate kitchen facilities

  • Adequate disease control / vaccination

  • Isolated facilities

  • Register of animals

  • Adequate identification of kennels

  • Adequate supervision

  • Adequate fire precautions

Additional comments


  • Extra photographs

  • Licence to be issued

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.