Information

  • Proprietor

  • Business Name & address

  • Proprietor email:

  • Council Registration No.

  • Conducted on

  • Prepared by

  • Location
  • Personnel

FLOOR PLAN/PHOTOS

  • Add drawing

  • Add media

BEDROOMS

  • Do bedrooms need to be measured?

  • BEDROOM
  • Size of bedroom (sq.m.):

  • Max no. persons permitted:

  • No. of beds:

  • No. of persons currently residing in this room:

  • Add media

  • Do no. of occupants comply re overcrowding?

  • Are bedrooms clean & in good repair?

  • Are bedrooms (and any attached ensuites) cleaned before re-use?

  • Is bed linen provided?

  • Is the bed linen changed at least weekly and after re-use?

AMENITIES

Ensuites

  • Do bedrooms have ensuites?

  • Do amenities in ensuites need to be determined?

  • ENSUITE
  • Ensuite is off bedroom #

  • Amenities:

  • Add media

  • Are ensuites clean & in good repair?

Bathrooms

  • Does premises have communal bathroom(s)?

  • Do amenities in communal bathrooms need to be determined?

  • BATHROOM
  • Amenities:

  • Add media

  • Do no. of amenities comply with PH&WB requirements?<br><br>Note: 1 toilet, 1 bath/shower & 1 hand basin required for every 10 persons or part thereof.

  • Are toilets & bathrooms clean & in good repair?

  • Are toilet & bathing facilities at the premises adequate?

Laundry

  • Does premises have a laundry?

  • Amenities:

  • Add media

  • Is the laundry clean & in good repair?

KITCHEN

  • Is kitchen clean & in good repair?

COMMON AREAS

  • Are common areas clean & in good repair?

WATER/WASTEWATER

  • Is there adequate hot & cold water facilities?

  • Is there adequate clean drinking water?

  • Is all sewage & waste water discharged to sewer?

  • Are stormwater guttering, down pipes etc in good condition and connected to legal point of discharge?

REFUSE/WASTE MANAGEMENT

  • Are refuse receptacles sufficient & clean?

  • Is refuse disposed of regularily?

OUTSIDE AREAS

  • Are lawns & gardens well maintained?

  • Are there any outbuildings, garages, sheds etc?

  • Are these structures in good condition?

  • Are any outbuildings being occupied?

  • Are these outbuildings approved for occupancy?

ADDITIONAL

  • Is there a register of occupants?

  • Other comments

ITEMS REQUIRING ATTENTION

    Item

FOLLOW-UP INSPECTION

  • Is a follow-up inspection required?

  • Follow-up inspection scheduled for:

SIGN OFF

  • On site representative

  • Add drawing

  • Officer's signature

  • Add drawing

  • Public Health Unit ph: 9518 3539

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.