Lodging House Inspection Report

• Site conducted

  Select

• Phone Number:

• Email:

• Responsible Person

• Conducted on

  Date

Kitchen

• Food Storage

  Yes

  No

  N/A

• Cooking Facilities

  Yes

  No

  N/A

• Floors

  Yes

  No

  N/A

• Walls

  Yes

  No

  N/A

• Refrigerators

  Yes

  No

  N/A

• Hygiene/Cleanliness

  Yes

  No

  N/A

• Fire Extinguisher / Fire Blanket

  Yes

  No

  N/A

Water Supply

• Scheme / Rainwater / Borewater

Dining / Sitting Room

• Cleanliness

  Yes

  No

  N/A

• Room Size

Ensuite / Bathroom

• Self Closing Doors

  Yes

  No

  N/A

• Mechanical Ventilation

  Yes

  No

  N/A

• Adequate Lighting

  Yes

  No

  N/A

• Spa – Adequate Cleaning Program

  Yes

  No

  N/A

Rooms

• Cleanliness

  Yes

  No

  N/A

• Room Sizes (7.5m2 single/6.0m2 share)

  Yes

  No

  N/A

• Number of Rooms

• Smoke Detectors

  Yes

  No

  N/A

• Approved Locks

  Yes

  No

  N/A

Laundry

• Facilities

  Yes

  No

  N/A

• Cleanliness

  Yes

  No

  N/A

• Contracted Out

  Yes

  No

  N/A

Fire Prevention & Control

• Smoke Detectors

  Yes

  No

  N/A

• Fire Extinguishers

  Yes

  No

  N/A

• Approved Locks

  Yes

  No

  N/A

General

• Register of Lodgers

  Yes

  No

  N/A

• Number of Rooms

• Number of Lodgers

• Exit Signs (>300m2)

  Yes

  No

  N/A

• Thank you for your assistance with the City’s Environmental Health Officer’s assessment of the above premises. Should you have any queries please contact the City of Busselton’s Environmental Health Services section on (08) 9781 0444.

• Assessed by: (Officers Name and Signature)

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