Information

  • Name of Premises

  • Address of premises

  • Contact Name

  • Contact Number

  • Business email

  • Council Food Registration No. (if applicable)

  • Conducted on

  • Prepared by

  • Location
  • Personnel

CERTIFIED SPECIALIST TOBACCONIST

  • 1. Is the certificate in a conspicuous position?

  • Action taken/required:

  • 2. Is there only one tobacco display area?

  • Action taken/required:

  • 3. Is the display of tobacco product facings less than 4 square metres (excluding cigars in an operating humidor)?

  • Action taken/required:

  • 4. Is there only one front facing of each product line on display?

  • Action taken/required:

  • 5. Is the 'We don't sell tobacco to U/18's' sign displayed?

  • Action taken/required:

  • 6. Is the health warning sign displayed?

  • Action taken/required:

  • 7. Are staff being trained regarding cigarette sales to minors?

  • Action taken/required:

  • 8. Are staff aware of identification that should be sighted when someone purchasing cigarettes who may be under the age of 25?

  • Action taken/required:

  • Only identification that provides photographic proof of age is acceptable. For example: Victorian or interstate proof-of-age card Victorian or interstate driver's license Australian or international passport Keypads Victorian learner's permit

  • 9. Is there any tobacco advertising within the store (inc. non-branded tobacco advertising such as backlit sign of lighters and/or matches)?

  • Action taken/required:

  • 10. No 'discounted' or 'cheap' cigarette signs?

  • Action taken/required:

  • 11. No cigarette cartons displayed.

  • Action taken/required:

  • 12. Not selling single cigarettes or packets of less than 20?

  • Action taken/required:

  • 13. Other

  • Action taken/required:

Additional

  • Does the retail outlet operate from premises separated from all other retail premises by walls?

  • Do the signs at the front of the retail outlets clearly show that it is a tobacconist by using branding containing any or all of the words tobacconist, tobacco, cigars, cigarettes?

  • Does the retail outlet operate from premises opening directly or exiting from any other retail premises?

  • Does the retail outlet identify itself as a newsagent?

  • Does the retail outlet contain any internal or external branding identifying itself as a newsagent?

  • Does the retail outlets sell print materials other than local state and national daily and weekly newspapers?

  • Does the retail outlet sell any food or beverages other than low risk and shelfstable foods and beverages?

  • Does the retail outlets sell milk or dairy products including UHT or in other shelf-stable products?

  • Does the retail outlet sell any bread or other bakery products?

  • Does the retail outlet sell eggs or breakfast cereals?

  • Does the retail outlets sell products or services for children or adolescents?

OVERALL ASSESSMENT RESULT

  • Overall Tobacco Retailer Assessment result:

  • Is a follow-up visit required?

FOLLOW-UP INSPECTION

  • Follow-up visit due on:

ADDITIONAL COMMENTS

SIGN OFF

  • On site representative

  • Auditor's signature

  • 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.