Title Page
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Site conducted
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Business name
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Manager/proprietor
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Telephone number
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Email address
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Premises address
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Conducted on
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Prepared by
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INSTRUCTIONS
1. Answer the questions below by selecting the most appropriate response.
2. Add photos and notes as necessary evidences
3. To add a corrective measure, click ""Add Action"", provide a description, assign to a member, set priority, and due date
4. Complete the audit by providing a digital signature
Management
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1 Register of lodgers (kept in lodging house)
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2 Room maintenance (clean, sound, undamaged)
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3 Room occupancy/usage (no extra beds)
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4 Retention of room keys (duplicate keys)
Sanitary Conveniences
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5 Toilets
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6 Showers
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7 Basins
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8 Misc. (signs, screens, lighting)
Laundry
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9 Fixtures
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10 Finished surfaces
Kitchen
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11 Floor area
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12 Cooking facilities (ovens and 4 burner stove)
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13 Food Standards Code Compliance
Dining/Lounge Rooms
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14 Floor area
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15 Finished surfaces
Access/Egress Doors
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16 Approved locking device
Fire Safety
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17 Emergency passage lights
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18 Fire blanket (within 2m of cooking area)
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19 Exit signage
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20 Fire fighting appliances (clearly visible)
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21 Access ways unobstructed
Sleeping Rooms
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22 Floor space (bed 4m2 p/p or bunks 2m2 p/p)
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23 Illumination/ventilation
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24 Bedding mattress protector etc.
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25 Materials fire rating
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26 No smoking signs
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27 Emergency lighting/smoke detectors
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28 Doors to be numbered
General Cleanliness
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29 Ablutions
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30 Kitchen
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31 Living areas
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32 Sleeping areas
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33 Laundry
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34 Linen/towels etc.
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Other comments
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Please attend to any outstanding items by the due date. For enquiries contact the officer on the number below.
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Reinspection Date
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I have read and I understand the contents of this assessment. Proprietor/staff name and signature
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Officer name and signature
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Officer contact number
