Prescribed Accomodation Assessment

• Premises Name

• Trading Name

• Document No.

• Conducted on

  Date
• Location
  Address

• Registered Name

• Council Registration Number

• Property File Number

• Name of proprietor or person in attendance

• Email

• Officer

  Select Alana Nolen Brooke Keher Jacinta McLean Malcolm Hare Samuel Judd Jeremy Draper Helen Eyre Joel Bray

  • Alana Nolen
  • Brooke Keher
  • Jacinta McLean
  • Malcolm Hare
  • Samuel Judd
  • Jeremy Draper
  • Helen Eyre
  • Joel Bray

• Reason for Assessment

  New Premises Assessment

  Mandatory Assessment

  Routine Inspection

  Transfer Inspection

  Complaint Investigation

FLOOR PLAN

• Add drawing

  Drawing

• Add media

  Media

AMENITIES

BEDROOMS

• Do bedrooms need to be measured?

  Yes

  No

  Existing Measurements
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

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  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

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

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  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

• A register of occupants of prescribed accommodation
  
  (1) A proprietor of prescribed accommodation must keep a register recording—
  (a) the names and addresses of persons occupying the accommodation; and
  (b) the dates of their arrival and departure.
  
  The proprietor must maintain the register for at least 12 months after the last date in the register.

• Other comments

ITEMS REQUIRING ATTENTION

Item

• A proprietor of prescribed accommodation must maintain the prescribed accommodation and all bedrooms, toilets, bathrooms, laundries, kitchens, living rooms and any common areas provided with the accommodation—
  (a) in good working order; and
  (b) in a clean, sanitary and hygienic condition; and
  (c) in a good state of repair.

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

• Environmental Health Contacts Phone 50188218 health@mildura.vic.gov.au