Title Page

  • no label


  • Business Name

  • Add location
  • Phone No.

  • Mobile No.

  • Add media

Emergency Contact Details

  • Name

  • Mobile No.

NSW Food Authority Details

  • Registration No.

Vehicle Details

  • Make

  • Model

  • Rego

Tank Details

  • Make

  • Capacity (Lts)


  • Has the tank, container hoses or fittings been used to cart hazardous material such as recycled water, petrochemicals or human or animal waste ?

  • If 'Yes', detail

  • Has the tank, container horse or fittings been used to cart any non-hazardous substances other than drinking water, for example milk or wine ?

  • If 'Yes', detail

  • Sight log book

  • Sight copy of Council approval

  • Sight copy of NSW Health Guidelines for Water Carters and Narromine Shire Drinking (Potable) Water supply - Water Carters Policy

  • Sight copy of NSW Food Authority Registration Certificate

  • Visual Inspection Result

Office Use

  • Select date

  • Inspector

  • Fees

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.