Title Page
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Organisation
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Officer Name
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Date
Details of Premises Visited
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Premises Organisation Name
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Are you able to complete inspection
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Details of Type of Premises Visited
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Address
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Local Government Area (LGA)
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Phone Number (If available)
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ABN Number (If available)
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Commencement Time of Observation
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End of Observation Time
Observations
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Is the organisation open or closed
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Observed car numbers around facility
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Observed empty spaces of facility car park
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Observed people numbers
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PPE adherence - primary mask wearing
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Adherence to social distancing
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Observed car pooling
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Other observations / Comments
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Follow up premises
