Leichhardt Municipal Council Regulated Premises Inspection Report

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Business Details

• Select date

  Date

• Cooling tower / Warm water system

  Cooling Tower

  Warm Water Systems

Compliance with Public Health (Microbial Control) Regulation

• Operation & maintenance manual provided

  Yes

  No

  N/A

• Manuals comply with AZ/NZS 3666.6/2002

  Yes

  No

  N/A

• Maintenance records up to date

  Yes

  No

  N/A

• Maintenance records located on site

  Yes

  No

  N/A

• Equipped with an automatic process of disinfection

  Yes

  No

  N/A

• Is tower/s connected to sewer?

  Yes

  No

  N/A

• Certified by a competent person

  Yes

  No

  N/A

• Expiry date of Certificate

Compliance with Clause 11 Public Health (Microbial Control) Regulation - Mantenance

• Chemicals stored satisfactory

  Yes

  No

  N/A

• Access for maintenance satisfactory

  Yes

  No

  N/A

• System inspected monthly for past 12 months

  Yes

  No

  N/A

• Cleaning interval not exceeding 6 months

  Yes

  No

  N/A

Compliance with Section 45 of the Public Health Act

• Contractor Name -

• Address -

• Phone Number -

Comments

• Re-Inspection Required

  Select 24 hours 7 days 14 Days 28 Days 60 days 90 dayside

  • 24 hours
  • 7 days
  • 14 Days
  • 28 Days
  • 60 days
  • 90 dayside

• Contractors Signature

  Sign

• Council Officers Name

  Marc Goodall

  Mario Mouxouris

  Michael Hendry

• Council Health Officer

  Sign