Prescribed Accommodation - New Premises Inspection (City Of Monash)

• Proprietor

• Business Name & address

• Proprietor email:

• Council Registration No.

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

FLOOR PLAN

• Add drawing

  Drawing

• Add media

  Media

BEDROOMS

• Do bedrooms need to be measured?

  Yes

  No
BEDROOM

• Size of bedroom (sq.m.):

• Max no. persons permitted:

  Select Room not available for rent No access to bedroom < 7.5 sq.m. 0 persons. Insufficient size. 7.5 to < 10 sq.m. 1 person for more than 31 days, 2 persons for 31 days or less. 10 to < 12 sq.m. 1 person for stays more than 31 days, 3 persons for stays of 31 days or less. 12 to < 14 sq.m. 2 persons for stays more than 31 days, 4 persons for stays 31 days or less. 14 to < 16 sq.m. 2 persons for stays more than 31 days, 5 persons for stays 31 days or less. 16 to < 18 sq.m. 3 persons for stays more than 31 days, 6 persons for stays 31 days or less 18 to < 20 sq.m. 3 persons for stays more than 31 days, 7 persons for stays 31 days or less 20 to < 22 sq.m. 4 persons for stays more than 31 days, 8 persons for stays 31 days or less 22 to < 24 sq.m. 4 persons for stays more than 31 days, 9 persons for stays 31 days or less 24 to < 26 sq.m. 5 persons for stays more than 31 days, 10 persons for stays 31 days or less 26 to < 28 sq.m. 5 persons for stays more than 31 days, 11 persons for stays 31 days or less 28 to < 30 sq.m. 6 persons for stays more than 31 days, 12 persons for stays 31 days or less 30 to < 32 sq.m. 6 persons for stays more than 31 days, 12 persons for stays 31 days or less 32 to < 34 sq.m. 7 persons for stays more than 31 days, 14 persons for stays 31 days or less 34 to < 36 sq.m. 7 persons for stays more than 31 days, 15 persons for stays 31 days or less 36 to < 38 sq.m. 8 persons for stays more than 31 days, 16 persons for stays 31 days or less 38 to < 40 sq.m. 8 persons for stays more than 31 days, 17 persons for stays 31 days or less > 40 sq.m. Do calculation. Refer to Section 17(3) of the Public Health & Wellbeing Regulations 2009

  • Room not available for rent
  • No access to bedroom
  • < 7.5 sq.m. 0 persons. Insufficient size.
  • 7.5 to < 10 sq.m. 1 person for more than 31 days, 2 persons for 31 days or less.
  • 10 to < 12 sq.m. 1 person for stays more than 31 days, 3 persons for stays of 31 days or less.
  • 12 to < 14 sq.m. 2 persons for stays more than 31 days, 4 persons for stays 31 days or less.
  • 14 to < 16 sq.m. 2 persons for stays more than 31 days, 5 persons for stays 31 days or less.
  • 16 to < 18 sq.m. 3 persons for stays more than 31 days, 6 persons for stays 31 days or less
  • 18 to < 20 sq.m. 3 persons for stays more than 31 days, 7 persons for stays 31 days or less
  • 20 to < 22 sq.m. 4 persons for stays more than 31 days, 8 persons for stays 31 days or less
  • 22 to < 24 sq.m. 4 persons for stays more than 31 days, 9 persons for stays 31 days or less
  • 24 to < 26 sq.m. 5 persons for stays more than 31 days, 10 persons for stays 31 days or less
  • 26 to < 28 sq.m. 5 persons for stays more than 31 days, 11 persons for stays 31 days or less
  • 28 to < 30 sq.m. 6 persons for stays more than 31 days, 12 persons for stays 31 days or less
  • 30 to < 32 sq.m. 6 persons for stays more than 31 days, 12 persons for stays 31 days or less
  • 32 to < 34 sq.m. 7 persons for stays more than 31 days, 14 persons for stays 31 days or less
  • 34 to < 36 sq.m. 7 persons for stays more than 31 days, 15 persons for stays 31 days or less
  • 36 to < 38 sq.m. 8 persons for stays more than 31 days, 16 persons for stays 31 days or less
  • 38 to < 40 sq.m. 8 persons for stays more than 31 days, 17 persons for stays 31 days or less
  • > 40 sq.m. Do calculation.
  • Refer to Section 17(3) of the Public Health & Wellbeing Regulations 2009

• No. of beds:

  Select 1 single 2 single 3 single 4 single 5+ singles 1 double 2 double 3+ doubles 0 beds present No access

  • 1 single
  • 2 single
  • 3 single
  • 4 single
  • 5+ singles
  • 1 double
  • 2 double
  • 3+ doubles
  • 0 beds present
  • No access

• No. of persons currently residing in this room:

  Select 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 >20

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • >20

• Add media

  Media

• Do no. of occupants comply re overcrowding?

  Yes

  No

  N/A

• Are bedrooms clean & in good repair?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is bed linen provided?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

AMENITIES

Ensuites

• Do bedrooms have ensuites?

  Yes

  No

  N/A

• Do amenities in ensuites need to be determined?

  Yes

  No
ENSUITE

• Ensuite is off bedroom #

• Amenities:

  Select Toilet Shower Bath Spa bath Basin

  • Toilet
  • Shower
  • Bath
  • Spa bath
  • Basin

• Add media

  Media

• Are ensuites clean & in good repair?

  Yes

  No

  N/A

Bathrooms

• Does premises have communal bathroom(s)?

  Yes

  No

• Do amenities in communal bathrooms need to be determined?

  Yes

  No
BATHROOM

• Amenities:

  Select Toilet Shower Bath Spa bath Basin

  • Toilet
  • Shower
  • Bath
  • Spa bath
  • Basin

• Add media

  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.

  Yes

  No

  N/A

• Are toilets & bathrooms clean & in good repair?

  Yes

  No

  N/A

• Are toilet & bathing facilities at the premises adequate?

  Yes

  No

  N/A

Laundry

• Does premises have a laundry?

  Yes

  No

• Amenities:

  Select Washing machine Trough Dryer

  • Washing machine
  • Trough
  • Dryer

• Add media

  Media

• Is the laundry clean & in good repair?

  Yes

  No

  N/A

KITCHEN

• Is kitchen clean & in good repair?

  Yes

  No

  N/A

COMMON AREAS

• Are common areas clean & in good repair?

  Yes

  No

  N/A

WATER/WASTEWATER

• Is there adequate hot & cold water facilities?

  Yes

  No

  N/A

• Is there adequate clean drinking water?

  Yes

  No

  N/A

• Is all sewage & waste water discharged to sewer?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

REFUSE/WASTE MANAGEMENT

• Are refuse receptacles sufficient & clean?

  Yes

  No

  N/A

• Is refuse disposed of regularily?

  Yes

  No

  N/A

OUTSIDE AREAS

• Are lawns & gardens well maintained?

  Yes

  No

  N/A

• Are there any outbuildings, garages, sheds etc?

  Yes

  No

  Don't know

• Are these structures in good condition?

  Yes

  No

  N/A

• Are any outbuildings being occupied?

  Yes

  No

  Don't know

• Are these outbuildings approved for occupancy?

  Yes

  No

  N/A

ADDITIONAL

• Is there a register of occupants?

  Yes

  No

  N/A

• Other comments

ITEMS REQUIRING ATTENTION

Item

FOLLOW-UP INSPECTION

• Is a follow-up inspection required?

  Yes

  No

• Follow-up inspection scheduled for:

  Date

SIGN OFF

• On site representative

  Sign

• Add drawing

  Drawing

• Officer's signature

  Sign

• Add drawing

  Drawing

• Public Health Unit ph: 9518 3539