Information

  • Liquid Trade Waste Reference Number

  • Site/Client

  • Location
  • Lot Section & DP

  • Parcel number

  • Assessment number

  • Conducted on

Contact Details

  • Contact Person

  • Contact phone number/s

  • Contact email address

  • Owners name

  • Owners mailing address

Premises & Inspection Details

  • Approval number

  • Business Type

  • Classification

  • Category

  • Water Meter #

  • Meter size

  • Liquid Trade Waste Discharge Factor

  • Sewer Discharge Factor

  • Sewerage Treatment Plant catchment

  • Sewerage Pump Station catchment

  • Drawing of system (if required)

Reason for Inspection

  • Reason

PRETREATMENT

Equipment Type

Oily Water Separator

  • Required

  • In Place

  • Maintained

  • Condition OK

  • Compliant

Waste Arrestors -FW

  • Required

  • In Place

  • Maintained

  • Condition OK

  • Compliant

Collection Pits / Pumps

  • Required

  • In Place

  • Maintained

  • Condition OK

  • Compliant

Pit Screens

  • Required

  • In Place

  • Maintained

  • Condition OK

  • Compliant

Sink Screens

  • Required

  • In Place

  • Maintained

  • Condition OK

  • Compliant

Other (please describe)

  • Required

  • In Place

  • Maintained

  • Condition OK

  • Compliant

  • Additional notes

Containment Methods

  • STORMWATER

  • Isolated from sewer

  • Roofing

  • Bunding

  • CHEMICAL / OIL STORAGE

  • Isolated from sewer

  • Roofing

  • Bunding

  • Additional notes

Housekeeping/other

  • Spill Procedure Satisfactory

  • Separator Site Accessible

  • Separator Maintenance Documents

  • Oil disposal by DECCW approved contractor

  • Coolant disposal by DECCW approved contractor

  • Spent Filters disposal to DECCW approved site

  • Oily Rags & Absorbent material disposal to DECCW approved site

  • Activities within classification /approval

  • Current Material Safety Data Sheets (MSDSs) available

  • Correct Back flow prevention device in place

  • Back flow Prevention Device certification to Council current

  • Additional notes

FOLLOW UP REQUIREMENTS

General Comments

Information to be provided to Council

Further Action

  • Further action required

  • Comments

Fees to be Charged

  • Inspection fee

  • Administration fee

I have read this report and understand the contents.

  • Owner / Employee signature

  • Officers Name

  • Officers signature

  • NB: Assessment report contains findings from date/time of inspection only

Explanatory notes

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.