Title Page

  • Manager / Proprietor

  • Assessment No.

  • Health Premises No.

  • Date

  • Inspection Frequency

  • Prepared by

  • Premises Address

    1. Please answer "Compliant", "Non-Compliant" or "N/A" on the questions below.
    2. Add Photos and Notes by clicking on the Paperclip icon
    3. To add a Corrective Action click on the Paperclip icon then "Add Action", provide a description, assign to a member, set priority, and due date
    4. Complete audit by providing digital signature
    5. Share your report by exporting as PDF, Word, Excel or Web Link

Certification and documentation

  • Certificate of approval displayed

  • Emergency lighting maintenance records

  • Evacuation plan

Steps and landing

  • Guard rails provided where required

  • Hand rails where required

Exit and egress

  • Exit doors open in direction of egress

  • Exit doors not fitted with barrel bolts

  • Exits unobstructed

  • Exit signs visible and illuminated

  • ‘NO ESCAPE’ signs where required

  • ‘EMERGENCY EXIT’ signs where required

Fans and heaters

  • Fixed fans >2.4m above floor level

  • Heaters >2.1m above floor

  • Heaters >0.6m from combustible ceilings

Sanitary facilities

  • Gender signage

  • Adequate lighting

Fire prevention and control

  • Stage curtains fire retardant

  • Fire equipment maintained


  • Interior lighting adequate

  • No bare lamps <2.4m from floor level

  • External lighting adequate

  • All exits and exit paths lighting adequate

General maintenance

  • Materials, fittings, seating, appliances etc are maintained and in a fit sanitary condition


  • Fixed seating secured in groups of 4

  • Aisles provided on either side of rows, where seats arranged in rows of 10 to 42

Public buildings used for entertainment

  • Compliance with Part 5, Division 2


  • General Comments

  • Assessed by: (Officer's Name and Signature)

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.