• Health licence #:

  • Name of the Caravan Park:

  • Managers/representatives:

  • Register kept?

  • Conducted on

  • Prepared by

  • Location

Caravan park information

  • Number is sites (total)

  • Number of sites (permanent)

  • Number of sites with ensuites

  • Number of On-site cabins

  • Ensuites

  • No ensuites

  • Tent sites

  • Relocatable home sites

Ablution Facilities

  • Number per block

  • Male toilets

  • Urinals (meters)

  • Hand wash basins

  • Showers/baths

  • Female toilets

  • Showers/baths

  • Hand wash basins

  • Unisex disable facilities provided?

  • Privacy assured?

  • Hot & cold water provided

  • Facilities not closer than 6m and not further than 100m to sites?

  • Toilet and shower block kept in a clean and healthy condition

  • Comments

  • Photos

Laundry Facilities

  • Number per block

  • Twin tubs

  • Washing machines

  • Clothes hoists

  • Dryers

  • Number of irons

  • Number of ironing boards

  • Laundry facilities maintained in a clean and healthy condition

  • Comments

  • Photos

Are the site....

  • Numbered?

  • At least 3 meters apart?

  • Within 100 meters of water

  • Paved?

  • Connected/ have access to sewer/sullage?

  • Close to refuse storage/bins?


  • Garbage is stored in sealed containers and disposed of weekly

  • Is there a dump point facility provided at this Park?

  • Are the facilities clean, safe and sanitary?

  • Pool provided?

  • swimming pool inspection form


  • Signature of EHO

  • Signature of caravan park owner/ manager or person interviewed

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.