Information
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Reference No.
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Trading Name
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Company Name
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Conducted on
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Prepared by
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Location
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Personnel
A MORTUARY PREMISES DETAILS:
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Prop/Director:
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Email Address:
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Council Approval Identification Details:
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Contact Number
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ABN/ACN
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Person Interviewed
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Health Registration Number:
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Registration Details Complete?
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Registration details match with Council approval?
B AUDIT DETAILS
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1. Premises generally (Clause 5)
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Only approved mortuary being used for body preparation? (1)
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Only approved mortuary being used for body storage? (2)
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Bodies not stored in a vehicle? (3)
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Holding room being used for body storage only? (4)
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Bodies not stored as a hospital? (5)
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2. Facilities for Body Preparation Rooms (Clause 6)
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Vehicle reception area adjacent to body preparation room? (1)(a)
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Vehicle reception area screen from public view? (1)(a)
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Hand wash basin with adequate hot and cold water and hands free operation? (1)(b)
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Sufficient slabs, tables and fittings?
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Slabs, tables and fittings impervious and drained for cleaning? (1)(c)
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Refrigerated body storage facilities for at least two adults? (1)(d)
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Temperature:
- -20
- -19
- -18
- -17
- -16
- -15
- -14
- -13
- -12
- -11
- -10
- -9
- -8
- -7
- -6
- -5
- -4
- -3
- -2
- -1
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
- 20
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Less than 5 C?
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Impervious containers with lids; hands free operation for solid wastes? (1)(e)
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Only bodies stored in body refrigerator?
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3. Waste Disposal (Clause 7)
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Solid wastes disposed as contaminated (clinical) waste?
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Waste observed in container:
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Name of clinical waste contractor:
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4. Vehicles (Clause 8)
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Hearse: Make, Model and Registration (1)(a):
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Collection vehicle: Make, model and registration (1)(b):
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Mortuary transport service or freight carrier? (2)
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Bodies placed only in vehicle body area? (3)
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Vehicle body area not used for other purposes? (4)
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Vehicle clean of exudates? (5)
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Un-embalmed bodies transported less than 8 hours? (7)
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Body bags supplied in vehicle? (CI 13)
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Protective clothing in vehicle? (CI 14)
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5. Mortuary Register of Body Preparation (Clause 18)
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Register Sighted? (1)
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Entries complete for disposed bodies? (3)
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Entries reconciled with each body prepared? (2 & 3)
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6. Retention of Bodies (Clause 10)
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All bodies held in mortuary or holding room? (1)
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All bodies kept under refrigeration? (2)
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Reason for any body not in refrigeration? (3)
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All un-embalmed bodies kept less than 7 working days after certificate? (4)
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7. Embalming of bodies (Clause 11 & 12)
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Any un-embalmed bodies on premises? (*)
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Name and qualification of embalmer? (11,1)
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Qualification approved?
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Any body with List B disease embalmed? (11,2)
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Any body with List A disease pierced by unqualified person? (12)
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8. Body Bags (Clause 13)
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All bodies in body bags and identified? (1)
C RECOMMENDATIONS
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Recommendation;
D ACTION TAKEN
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Action;
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(*) = Not a legislative requirement
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NB:
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Prop/Director Signature:
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EHO/Officer Signature: