Information
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Proprietor
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Business name & address
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Conducted on
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Prepared by
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Location
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Personnel
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Add media
INTERVIEW
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The purpose of this interview is to determine if the accommodation at this premises is operating as a prescribed accommodation (eg rooming house) under the Public Health & Wellbeing Act 2008. If the premises is found to be operating as an unregistered rooming house then penalties may apply & measures will need to be taken to ensure the premises either ceases to operate as a prescribed accommodation or complies with all relevant legislation to operate as a prescribed accommodation.
INTERVIEWEE
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Interviewee name & contact details:
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Does interviewee reside at the premises?
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What is the interviewees position?
- Property owner
- Tenant
- Lessee
- Sub-lessee
- Property manager/agent
- Associate of property owner
- Friend of property owner
- Company
- Third party
- Other
PROPRIETOR
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Who is the proprietor of this accommodation premises?
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Does the proprietor reside at the premises?
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Proprietor's contact details:
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What is the proprietor's position?
- Property owner
- Tenant
- Lessee
- Sub-lessee
- Property manager/agent
- Associate of property owner
- Friend of property owner
- Company
- Third party
- Other
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Provide details:
BEDROOMS
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What is the total number of bedrooms at this premises?
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
- 20
- Exceeds 20
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How many of these bedrooms are there available for rent?
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
- 20
- Exceeds 20
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Are there room numbers on bedroom doors?
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Are there locks on bedroom doors?
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No. of people who may occupy the rooms available for rent:
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
- 20
- Exceeds 20
MANAGEMENT
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Who manages the accommodation?
- Owner
- Proprietor
- Manager
- Real estate agent
- Tenant themselves
- Sub-lessee
- Other
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Details:
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How is the accommodation advertised?
- Advertisement - internet
- Advertisement - paper
- Advertisement - notice board
- Real estate agent
- Through friends (word of mouth)
- Other
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Details:
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Who do tenants pay rent to?
- Owner
- Proprietor
- Manager
- Real estate agent
- Tenant themselves
- Sub-lessee
- Other
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Details:
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If someone moves out, who organises replacement tenant?
- Owner
- Proprietor
- Manager
- Real estate agent
- Tenant themselves
- Sub-lessee
- Other
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Details:
RESIDENTS
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What is the total number of people currently residing at the premises?
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
- 20
- Exceeds 20
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Does the proprietor and/or any of the proprietor's family reside at the premises?
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How many persons excluding the proprietor and the proprietor's family currently reside at the premises?
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
- 20
- Exceeds 20
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How did the tenants become aware of this accommodation?
- Advertisement - internet
- Advertisement - paper
- Advertisement - notice board
- Real estate agent
- Through friends (word of mouth)
- Other
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Details:
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Did the tenants move in together at same time?
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Details:
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What is the relationship of residents to the owner?
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Details:
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What is the relationship of residents to each other?
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Provide further details:
TENANCY
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Are all residents named on single lease with the owner?
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Do residents have a lease or sub-lease agreement in relation to their room only?
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Do residents have the sole right of access to their bedrooms?
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Length of stay of residents:
COMMUNAL FACILITIES
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Are there shared or communal bathroom/cooking/laundry facilities?
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Is there a shared or communal living area?
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Do bedrooms have their own toilet/shower/cooking facilities?
ROOMING HOUSE STATUS
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The preliminary interview confirmed the premises to be:
INSPECTION APPOINTMENT
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Has date for premises inspection been made?
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Select date
OTHER DEPARTMENT REQUIREMENTS
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Additional information provided to the interviewee/proprietor?
- Prescribed Accommodation Information Sheet - Health Requiremnts
- Requirements for Shared Accommodation - Building, Health & Town Planning
- Minimum Standards in Rooming Houses - Consumer Affairs Victoria
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Details:
ADDITIONAL INFORMATION
SIGN OFF
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On site representative
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Add drawing
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Auditor's signature
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Add drawing
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Public Health Unit ph: 9518 3539
