Tobacco - Enclosed Workplace/Eating Establishment Inspection (City of Monash)

• Name of Premises

• Address of premises

• Contact Name

• Contact Number

• Business email

• Council Food Registration No. (if applicable)

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

ENCLOSED WORKPLACE/EATING ESTABLISHMENT

• Type of establishment:

  Licensed premises

  Gaming

  Shopping centre

  Other

• 1. Are no smoking signs posted as required (licensed premises, shopping centre, bingo centre, Casino, cafe/restaurants)?

  Yes

  No

  N/A

• Action taken/required:

  Select Follow-up required Verbal warning with education Warning letter Infringement Prosecution Other

  • Follow-up required
  • Verbal warning with education
  • Warning letter
  • Infringement
  • Prosecution
  • Other

• 2. Any signs that smoking may be occurring in the workplace (e.g. butts smell)?

  Yes

  No

  N/A

• Action taken/required:

  Select Follow-up required Verbal warning with education Warning letter Infringement Prosecution Other

  • Follow-up required
  • Verbal warning with education
  • Warning letter
  • Infringement
  • Prosecution
  • Other

• 3. Is the vending machine located in a correct position (in the line of sight of the bar area not more than 5 metres from the outer edge of the bar area in a licensed premises, or in the line of sight of counter at a gaming venue or casino, or next to the counter at a bottle shop)?

  Yes

  No

  N/A

• Action taken/required:

  Select Follow-up required Verbal warning with education Warning letter Infringement Prosecution Other

  • Follow-up required
  • Verbal warning with education
  • Warning letter
  • Infringement
  • Prosecution
  • Other

• 4. Are tobacco products and packaging covered and not visible inside or outside of the vending machine (price tickets permitted)?

  Yes

  No

  N/A

• Action taken/required:

  Select Follow-up required Verbal warning with education Warning letter Infringement Prosecution Other

  • Follow-up required
  • Verbal warning with education
  • Warning letter
  • Infringement
  • Prosecution
  • Other

• 5. Is the smoking status of any outdoor dining and drinking area correct?

  Yes

  No

  N/A

• Action taken/required:

  Select Follow-up required Verbal warning with education Warning letter Infringement Prosecution Other

  • Follow-up required
  • Verbal warning with education
  • Warning letter
  • Infringement
  • Prosecution
  • Other

• 6. Other

  Compliant

  Non-compliant

  Not Applicable

  Info

• Action taken/required:

  Select Follow-up required Verbal warning with education Warning letter Infringement Prosecution Other

  • Follow-up required
  • Verbal warning with education
  • Warning letter
  • Infringement
  • Prosecution
  • Other

Inform on

• The need for the entire enclosed workplace to be smoke-free at all times.

  Done

  Not done

  N/A

• Smoking status of a workplace never changes even if doors and windows are open.

  Done

  Not done

  N/A

• Smoking status of an outdoor area can change if awning or similar are drawn.

  Done

  Not done

  N/A

• Occupy must not provide ashtrays matches lighters or any other things designed to facilitate smoking.

  Done

  Not done

  N/A

• If occupier witnesses smoking in their workplace they should request that the person extinguish the cigarette.

  Done

  Not done

  N/A

• Where possible designate an outside area as the area where smoking is permitted.

  Done

  Not done

  N/A

• Where possible designate an outside area as the area where smoking is permitted.

  Done

  Not done

  N/A

• A cigarette butt bin should be provided in designated outdoor smoking areas.

  Done

  Not done

  N/A

• Educating new staff regarding the smoke-free and closed works place.

  Done

  Not done

  N/A

OVERALL ASSESSMENT RESULT

• Overall Tobacco Retailer Assessment result:

  Compliant

  Non-compliant

• Is a follow-up visit required?

  Yes

  No

FOLLOW-UP INSPECTION

• Follow-up visit due on:

  Date

ADDITIONAL COMMENTS

SIGN OFF

• On site representative

  Sign

• Auditor's signature

  Sign

• Public Health Unit ph: 9518 3539