Information
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Name of Premises
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Address of premises
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Contact Name
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Contact Number
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Business email
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Council Food Registration No. (if applicable)
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Conducted on
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Prepared by
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Location
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Personnel
CERTIFIED SPECIALIST TOBACCONIST
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1. Is the certificate in a conspicuous position?
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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2. Is there only one tobacco display area?
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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3. Is the display of tobacco product facings less than 4 square metres (excluding cigars in an operating humidor)?
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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4. Is there only one front facing of each product line on display?
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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5. Is the 'We don't sell tobacco to U/18's' sign displayed?
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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6. Is the health warning sign displayed?
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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7. Are staff being trained regarding cigarette sales to minors?
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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8. Are staff aware of identification that should be sighted when someone purchasing cigarettes who may be under the age of 25?
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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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
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9. Is there any tobacco advertising within the store (inc. non-branded tobacco advertising such as backlit sign of lighters and/or matches)?
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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10. No 'discounted' or 'cheap' cigarette signs?
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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11. No cigarette cartons displayed.
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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12. Not selling single cigarettes or packets of less than 20?
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
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13. Other
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Action taken/required:
- Follow-up required
- Verbal warning with education
- Warning letter
- Infringement
- Prosecution
- Other
Additional
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Does the retail outlet operate from premises separated from all other retail premises by walls?
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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?
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Does the retail outlet operate from premises opening directly or exiting from any other retail premises?
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Does the retail outlet identify itself as a newsagent?
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Does the retail outlet contain any internal or external branding identifying itself as a newsagent?
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Does the retail outlets sell print materials other than local state and national daily and weekly newspapers?
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Does the retail outlet sell any food or beverages other than low risk and shelfstable foods and beverages?
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Does the retail outlets sell milk or dairy products including UHT or in other shelf-stable products?
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Does the retail outlet sell any bread or other bakery products?
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Does the retail outlet sell eggs or breakfast cereals?
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Does the retail outlets sell products or services for children or adolescents?
OVERALL ASSESSMENT RESULT
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Overall Tobacco Retailer Assessment result:
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Is a follow-up visit required?
FOLLOW-UP INSPECTION
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Follow-up visit due on:
ADDITIONAL COMMENTS
SIGN OFF
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On site representative
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Auditor's signature
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Public Health Unit ph: 9518 3539
