• Proprietor

  • Business name & address

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Add media


  • 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 name & contact details:

  • Does interviewee reside at the premises?

  • What is the interviewees position?


  • Who is the proprietor of this accommodation premises?

  • Does the proprietor reside at the premises?

  • Proprietor's contact details:

  • What is the proprietor's position?

  • Provide details:


  • What is the total number of bedrooms at this premises?

  • How many of these bedrooms are there available for rent?

  • Are there room numbers on bedroom doors?

  • Are there locks on bedroom doors?

  • No. of people who may occupy the rooms available for rent:


  • Who manages the accommodation?

  • Details:

  • How is the accommodation advertised?

  • Details:

  • Who do tenants pay rent to?

  • Details:

  • If someone moves out, who organises replacement tenant?

  • Details:


  • What is the total number of people currently residing at the premises?

  • Does the proprietor and/or any of the proprietor's family reside at the premises?

  • How many persons excluding the proprietor and the proprietor's family currently reside at the premises?

  • How did the tenants become aware of this accommodation?

  • Details:

  • Did the tenants move in together at same time?

  • Details:

  • What is the relationship of residents to the owner?

  • Details:

  • What is the relationship of residents to each other?

  • Provide further details:


  • Are all residents named on single lease with the owner?

  • Do residents have a lease or sub-lease agreement in relation to their room only?

  • Do residents have the sole right of access to their bedrooms?

  • Length of stay of residents:


  • Are there shared or communal bathroom/cooking/laundry facilities?

  • Is there a shared or communal living area?

  • Do bedrooms have their own toilet/shower/cooking facilities?


  • The preliminary interview confirmed the premises to be:


  • Has date for premises inspection been made?

  • Select date


  • Additional information provided to the interviewee/proprietor?

  • Details:



  • On site representative

  • Add drawing

  • Auditor'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.