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 Public Building Assessment
Follow Up Public Building Assessment
Complaint Public Building Assessment
New/Transfer Public Building Assessment
Section 39 Public Building Assessment
Routine Public Building Assessment Follow Up Public Building Assessment Complaint Public Building Assessment New/Transfer Public Building Assessment Section 39 Public Building Assessment
Proprietor/manager on site at time of assessment
Certification and Documentation
Certificate of Approval on premises and displayed
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Exit sign and emergency lighting log book on site
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Air handling system maintenance record kept onsite (for evaporative systems)
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Evacuation plan available and signage displayed
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Pest control program in place and records kept onsite (where applicable)
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
General Provisions and Maintenance
Refuse area well maintained and in a clean condition
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Exterior building condition satisfactory
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Interior building condition satisfactory
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Exit and Egress
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
Electrical Meter/Switch Ventilation and Heating Sanitary Facilities
Facilities in good repair/ hygiene and easily accessible
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Sanitary disposal provided in female and unisex facilities
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Lighting sufficient for building use and cleaning
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Fire Safety
Fire equipment serviced 6 monthly
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Curtains and decorative treatments fire retardant
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Flammable liquids stored properly
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Open fires guarded/approved
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Seating, Stairs, Aisles and Landings
Fixed seating secured to floor or grouped in 4's
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Rows less than 42 seats
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Aisles at end of seat rows clear to exits
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Raised areas provided with guard rails
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
Stairs provided with 2 hand rails
Compliant
Non-Compliant
Serious Non-Compliance
Not Verified During Assessment
N/A
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 - Public Building Assessment Report
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