Site conducted
Prepared by
Date & time conducted
Date
Location (if not in system)
Business Name (if not in system)
Risk Level
Low Risk
Medium Risk
High Risk
TBA
Reason for assessment
Select
Routine Lodging House Assessment
Follow Up Lodging House Assessment
Complaint Lodging House Assessment
New/Transfer Lodging House Assessment
Routine Lodging House Assessment Follow Up Lodging House Assessment Complaint Lodging House Assessment New/Transfer Lodging House Assessment
Proprietor/manager on site at time of assessment
Certification and Documentation
Name of premises and current Certificate displayed
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Number of Rooms
Maximum number of Lodgers
Lodgers Register maintained and viewed
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Records kept for emergency and exit lighting servicing
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Records kept for fire alarm system (where applicable)
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Pest control program in place and records kept
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Cleaning roster maintained
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Liquor Licence displayed
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Emergency evacuation plan
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Hallways
All rooms numbered
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Passageways and exits unobstructed
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Exit doors easily opened
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Approved latches and locks
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Exit paths clear and unobstructed, exit to open space
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Exit signs provided on all designated exits
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Exit signs clearly visible and illuminated
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
No escape signs where required
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Room condition
Room number
Adequate ventilation provided
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Storage provided for personal belongings
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Bed/s provided with bed head, mattress and pillow
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Mattress and pillow protectors fitted to all beds
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Smoke detectors and fire fighting equipment (where applicable)
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Door lock always openable from inside
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Sanitary conveniences
Signage provided
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Adequate lighting and ventilation provided
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Hot and cold water provided
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Clean, tidy and in good working order
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Walls, floors and ceilings structurally sound
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Kitchen
Adequate storage facilities
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Hand wash basin supplied with soap and paper towels
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Kitchen clean and tidy condition / good working order
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Dining & Lounge Room Laundry
Hot and cold water provided
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Laundry well maintained and kept clean and tidy
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Washing machines and troughs adequate in number
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Clothes drying facilities provided
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Fire Safety General
Floors, walls and ceilings in good condition
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Doors and windows operational
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Adequate lighting provided in the premises
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
External yard in good condition
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Storm water disposal adequate
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Refuse disposal General comments
Follow-up assessment fee for unsatisfactory work: Proprietor to be charged relevant fee for this assessment
Further Action
Routine assessment
Follow up assessment
Further action
Next Assessment Date (assessment may not be on this day)
Date
Authorised Officer Signature
Sign
link copied
Health Services
Health - Lodging House Assessment Report
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